Healthcare Provider Details

I. General information

NPI: 1619393808
Provider Name (Legal Business Name): JULIUS TYLER ADAMS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2014
Last Update Date: 08/24/2020
Certification Date: 08/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 BROAD ST STE 1000
ROME GA
30161-3062
US

IV. Provider business mailing address

113 BROAD ST STE 1000
ROME GA
30161-3062
US

V. Phone/Fax

Practice location:
  • Phone: 865-398-2253
  • Fax: 855-232-8604
Mailing address:
  • Phone: 865-398-2253
  • Fax: 855-232-8604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number3035
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA004475
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: