Healthcare Provider Details

I. General information

NPI: 1457472094
Provider Name (Legal Business Name): JOHN BLOUNT ADAMS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 07/29/2024
Certification Date: 07/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 MANCHESTER EXPY STE C001
COLUMBUS GA
31904-6877
US

IV. Provider business mailing address

2300 MANCHESTER EXPY STE 2001A
COLUMBUS GA
31904-6802
US

V. Phone/Fax

Practice location:
  • Phone: 706-324-3243
  • Fax: 706-324-3835
Mailing address:
  • Phone: 706-320-3126
  • Fax: 706-320-3054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number060696
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: