Healthcare Provider Details

I. General information

NPI: 1336219807
Provider Name (Legal Business Name): NICHOLAS V ADAMS DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11079 COLUMBIA ST
BLAKELY GA
39823-3447
US

IV. Provider business mailing address

PO BOX 470
BLAKELY GA
39823-0470
US

V. Phone/Fax

Practice location:
  • Phone: 229-724-7300
  • Fax: 229-724-7355
Mailing address:
  • Phone: 229-724-7300
  • Fax: 229-724-7355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN012547
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: