Healthcare Provider Details

I. General information

NPI: 1922218445
Provider Name (Legal Business Name): ADAM CHARLES HORNE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 08/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1610 BROADRICK DR
DALTON GA
30720-3012
US

IV. Provider business mailing address

1610 BROADRICK DR
DALTON GA
30720-3012
US

V. Phone/Fax

Practice location:
  • Phone: 706-279-1994
  • Fax: 706-279-9229
Mailing address:
  • Phone: 706-279-1994
  • Fax: 709-279-9229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number061596
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: