Healthcare Provider Details

I. General information

NPI: 1497026066
Provider Name (Legal Business Name): BERESHITH NOAH ADAMS NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2012
Last Update Date: 02/03/2026
Certification Date: 02/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1265 HIGHWAY 54 W STE 305
FAYETTEVILLE GA
30214-4537
US

IV. Provider business mailing address

1000 ASYLUM AVENUE SUITE 2109A
HARTFORD CT
06105
US

V. Phone/Fax

Practice location:
  • Phone: 770-719-5660
  • Fax:
Mailing address:
  • Phone: 860-714-5058
  • Fax: 860-714-8311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN-NP296172
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4881
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5013966
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberAPRN-NP296172
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: