Healthcare Provider Details

I. General information

NPI: 1275693517
Provider Name (Legal Business Name): ROBERT MCLAIN ADAMS IV MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2006
Last Update Date: 07/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 MILITARY CUTOFF RD SUITE 120
WILMINGTON NC
28405-2375
US

IV. Provider business mailing address

710 MILITARY CUTOFF RD SUITE 120
WILMINGTON NC
28405-2375
US

V. Phone/Fax

Practice location:
  • Phone: 910-254-4818
  • Fax: 910-254-4819
Mailing address:
  • Phone: 910-254-4818
  • Fax: 910-254-4819

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number2007-01359
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number2007-01359
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier5907819
Identifier TypeMEDICAID
Identifier StateNC
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: