Healthcare Provider Details

I. General information

NPI: 1528263936
Provider Name (Legal Business Name): JOHN DONALD ADAMS JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2007
Last Update Date: 10/18/2021
Certification Date: 10/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1421 N STATE ST SUITE 403
JACKSON MS
39202-1658
US

IV. Provider business mailing address

501 MARSHALL ST STE 301
JACKSON MS
39202-1687
US

V. Phone/Fax

Practice location:
  • Phone: 601-353-9900
  • Fax: 601-353-3654
Mailing address:
  • Phone: 601-353-9900
  • Fax: 601-353-3654

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number19554
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: