Healthcare Provider Details

I. General information

NPI: 1134394349
Provider Name (Legal Business Name): NATHAN HENRY ADAMS CFA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2008
Last Update Date: 04/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1217 UPPER BRUSH CREEK RD
FAIRVIEW NC
28730-9208
US

IV. Provider business mailing address

1217 UPPER BRUSH CREEK RD
FAIRVIEW NC
28730-9208
US

V. Phone/Fax

Practice location:
  • Phone: 828-545-6464
  • Fax:
Mailing address:
  • Phone: 828-545-6464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number107923
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: