Healthcare Provider Details

I. General information

NPI: 1942248166
Provider Name (Legal Business Name): MICHAEL G ADKISON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 01/03/2024
Certification Date: 01/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 HEALTH PARK BLVD SUITE 5008
ST AUGUSTINE FL
32086-3707
US

IV. Provider business mailing address

PO BOX 3012
ST AUGUSTINE FL
32085-3012
US

V. Phone/Fax

Practice location:
  • Phone: 904-810-0686
  • Fax: 770-237-1124
Mailing address:
  • Phone: 866-480-2246
  • Fax: 770-237-1124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberME97111
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberME97111
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: