Healthcare Provider Details

I. General information

NPI: 1033137658
Provider Name (Legal Business Name): DENNIS U ADAMS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 MAIN ST N
MENDENHALL MS
39114-3303
US

IV. Provider business mailing address

PO BOX 6227
PEARL MS
39288-6227
US

V. Phone/Fax

Practice location:
  • Phone: 601-847-3306
  • Fax: 601-847-5336
Mailing address:
  • Phone: 601-825-7280
  • Fax: 601-825-8130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number07609
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: