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General NPI Number Information
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NPI Number | 1205027448
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Entity Type | Individual
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Provider Name | JUSTIN MATHEW ADAMS NP-C
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Gender | Male
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Dates
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Enumeration Date | 08/05/2007
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Last Update Date | 08/05/2007
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Provider Practice Location Address
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Address Line | 613 CAMPUS DR STE 200
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City | ABINGDON
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State | VA
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Zip | 24210-9700
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Country | US
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Telephone | 276-628-5141
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Fax | 276-628-6889
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Provider Business Mailing Address
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Address Line | 15 PALISADES PT
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City | JOHNSON CITY
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State | TN
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Zip | 37601-3196
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 0024167471
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License Number State | VA
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