Healthcare Provider Details

I. General information

NPI: 1922488832
Provider Name (Legal Business Name): ADAM PRIESTWOOD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2015
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 W MADISON AVE
ATHENS TN
37303-3433
US

IV. Provider business mailing address

1011 W MADISON AVE
ATHENS TN
37303-3433
US

V. Phone/Fax

Practice location:
  • Phone: 423-435-9954
  • Fax: 423-435-9955
Mailing address:
  • Phone: 423-435-9954
  • Fax: 423-435-9955

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number10444
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: