Healthcare Provider Details

I. General information

NPI: 1013204742
Provider Name (Legal Business Name): ANDREW BLAINE ADAMS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2011
Last Update Date: 11/07/2024
Certification Date: 11/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

985 ROBERT BLVD STE 105
SLIDELL LA
70458-2063
US

IV. Provider business mailing address

64301 HIGHWAY 434
LACOMBE LA
70445-5411
US

V. Phone/Fax

Practice location:
  • Phone: 985-661-6215
  • Fax: 985-882-4501
Mailing address:
  • Phone: 985-882-4500
  • Fax: 985-882-4501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberT-2399
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number23130
License Number StateMS
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number337414
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: