Healthcare Provider Details

I. General information

NPI: 1730523259
Provider Name (Legal Business Name): ADAMS PROSTHETICS & ORTHOTICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2013
Last Update Date: 11/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5935 HIGHWAY 18 W STE A
JACKSON MS
39209-9626
US

IV. Provider business mailing address

5935 HWY W 18 SUITE A
JACKSON MS
39209
US

V. Phone/Fax

Practice location:
  • Phone: 601-665-4000
  • Fax: 601-665-4634
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: MRS. CHARLEEN D. MITCHELL
Title or Position: OWNER
Credential:
Phone: 601-564-3623