Healthcare Provider Details

I. General information

NPI: 1144242546
Provider Name (Legal Business Name): ROBERT E ADHAM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 04/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 CHEROKEE PROFESSIONAL PARK
MARYVILLE TN
37804-5155
US

IV. Provider business mailing address

275 CHEROKEE PROFESSIONAL PARK
MARYVILLE TN
37804-5155
US

V. Phone/Fax

Practice location:
  • Phone: 865-983-4090
  • Fax: 865-984-2308
Mailing address:
  • Phone: 865-983-4090
  • Fax: 865-984-2308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberMD25019
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: