Healthcare Provider Details

I. General information

NPI: 1710810890
Provider Name (Legal Business Name): MR. BILLY WAYNE ADAMS SR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3062 WISCONSIN AVE
VICKSBURG MS
39180-4820
US

IV. Provider business mailing address

3062 WISCONSIN AVE
VICKSBURG MS
39180-4820
US

V. Phone/Fax

Practice location:
  • Phone: 601-831-9082
  • Fax:
Mailing address:
  • Phone: 601-831-9082
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License Number802085806
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code146E00000X
TaxonomyCommunity Paramedic
License Number802085806
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: