Healthcare Provider Details

I. General information

NPI: 1003830563
Provider Name (Legal Business Name): ROBERT ADAMS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 12/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 N STATE ST STE 400
JACKSON MS
39202-1689
US

IV. Provider business mailing address

1225 N STATE ST
JACKSON MS
39202-2064
US

V. Phone/Fax

Practice location:
  • Phone: 601-944-1717
  • Fax: 601-944-9780
Mailing address:
  • Phone: 601-968-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number41677
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number41677
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: