Healthcare Provider Details

I. General information

NPI: 1649230970
Provider Name (Legal Business Name): ADRINE SUE ADAMS CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ADRENE SUE ADAMS CRNA

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 02/12/2024
Certification Date: 02/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ONE HOSPITAL DR
COLUMBIA MO
65212-0001
US

IV. Provider business mailing address

PO BOX 2564
MACON GA
31203-2564
US

V. Phone/Fax

Practice location:
  • Phone: 573-882-2568
  • Fax: 855-903-0985
Mailing address:
  • Phone: 478-746-5644
  • Fax: 478-745-4849

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR044170
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number2023050141
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: