Healthcare Provider Details

I. General information

NPI: 1346656808
Provider Name (Legal Business Name): YUSUFF A ADAMS LPN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2014
Last Update Date: 03/12/2025
Certification Date: 03/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 BALLYSHANNON DR
DACULA GA
30019-6513
US

IV. Provider business mailing address

250 BALLYSHANNON DR
DACULA GA
30019-6513
US

V. Phone/Fax

Practice location:
  • Phone: 470-424-0025
  • Fax:
Mailing address:
  • Phone: 470-424-0025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberPHCP011175
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number26NP07138400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: