Healthcare Provider Details

I. General information

NPI: 1134199250
Provider Name (Legal Business Name): JIMMIE D MCADAMS JR. DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2006
Last Update Date: 03/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6655 S YALE AVE LAUREATE PSYCHIATRIC CLINIC AND HOSPITAL
TULSA OK
74136-3326
US

IV. Provider business mailing address

PO BOX 21228 DEPARTMENT 31
TULSA OK
74121-1228
US

V. Phone/Fax

Practice location:
  • Phone: 918-491-5645
  • Fax: 918-491-5740
Mailing address:
  • Phone: 918-491-5645
  • Fax: 918-491-5740

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number2634
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: