Healthcare Provider Details

I. General information

NPI: 1568513935
Provider Name (Legal Business Name): JIMMY WAYNE ADAMS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2007
Last Update Date: 06/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6007 US ROUTE 60 E SUITE 304
BARBOURSVILLE WV
25504-1042
US

IV. Provider business mailing address

PO BOX 328
BARBOURSVILLE WV
25504-0328
US

V. Phone/Fax

Practice location:
  • Phone: 304-736-0825
  • Fax: 304-736-3199
Mailing address:
  • Phone: 304-736-0825
  • Fax: 304-736-3199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number1799
License Number StateWV

VIII. Authorized Official

Name: DR. JIMMY WAYNE ADAMS
Title or Position: OWNER
Credential: D.O.
Phone: 304-736-0825