Healthcare Provider Details

I. General information

NPI: 1679700199
Provider Name (Legal Business Name): CHARLES C. ADAMS, MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2009
Last Update Date: 04/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4085 CLOUD SPRINGS RD
RINGGOLD GA
30736-8411
US

IV. Provider business mailing address

4085 CLOUD SPRINGS RD
RINGGOLD GA
30736-8411
US

V. Phone/Fax

Practice location:
  • Phone: 706-861-7377
  • Fax: 706-861-7922
Mailing address:
  • Phone: 706-861-7377
  • Fax: 706-861-7922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number045378
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberMD0000020333
License Number StateTN

VIII. Authorized Official

Name: MRS. ELLEN M WINCHEL
Title or Position: PRACTICE MANAGER
Credential:
Phone: 706-861-7377