=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376475590
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | REX WALKER ADKISSON DDS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/01/2026
-----------------------------------------------------
Last Update Date | 06/01/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4129 S 1ST ST
-----------------------------------------------------
City | MILAN
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38358-3164
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 731-686-3956
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 125 WYNDCREST CV
-----------------------------------------------------
City | MEDINA
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38355-2200
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 13148
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------