Healthcare Provider Details

I. General information

NPI: 1669452645
Provider Name (Legal Business Name): DARLA ADAMS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1508 K V RD
VICTORIA VA
23974-2624
US

IV. Provider business mailing address

2709 BRIERWOOD RD
PETERSBURG VA
23805-2901
US

V. Phone/Fax

Practice location:
  • Phone: 434-696-2165
  • Fax: 434-696-1557
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101043911
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: