Healthcare Provider Details

I. General information

NPI: 1104051168
Provider Name (Legal Business Name): TRESSELYN DOUGLAS ADAMS PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2009
Last Update Date: 06/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1345 REDMOND CIR NW
ROME GA
30165-1307
US

IV. Provider business mailing address

PO BOX 538622
ATLANTA GA
30353-8622
US

V. Phone/Fax

Practice location:
  • Phone: 910-742-9243
  • Fax: 888-746-1787
Mailing address:
  • Phone: 910-742-9243
  • Fax: 888-746-1787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN112304
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN112304
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: