Healthcare Provider Details

I. General information

NPI: 1891181715
Provider Name (Legal Business Name): CECIL BENJAMIN ADAMS III CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: BEN ADAMS CRNA

II. Dates (important events)

Enumeration Date: 04/07/2015
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1705 TARBORO ST SW
WILSON NC
27893-3428
US

IV. Provider business mailing address

3100 SPRING FOREST RD STE 130
RALEIGH NC
27616-2880
US

V. Phone/Fax

Practice location:
  • Phone: 252-399-8040
  • Fax:
Mailing address:
  • Phone: 919-873-9533
  • Fax: 919-873-9821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number236693
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number236693
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: