Healthcare Provider Details

I. General information

NPI: 1003179946
Provider Name (Legal Business Name): MARY ALLISON ADAMS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2012
Last Update Date: 07/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1935 HOMER RD STE A
COMMERCE GA
30529
US

IV. Provider business mailing address

2727 PACES FERRY RD SE STE 1-1100
ATLANTA GA
30339-6151
US

V. Phone/Fax

Practice location:
  • Phone: 706-335-9060
  • Fax:
Mailing address:
  • Phone: 706-677-2250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN191947
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN191947
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: