Healthcare Provider Details

I. General information

NPI: 1093747941
Provider Name (Legal Business Name): ROBERT RALPH ADAMS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MARION VETERANS ADMINISTRATION MEDICAL CENTER 2620 PERKINS CREEK DR (PADUCAH CBOC)
PADUCAH KY
42001
US

IV. Provider business mailing address

1056 OAKLAWN DR
COOKEVILLE TN
38501-2910
US

V. Phone/Fax

Practice location:
  • Phone: 866-289-3300
  • Fax:
Mailing address:
  • Phone: 931-544-6002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD15631
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: