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General NPI Number Information
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NPI Number | 1578409272
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Entity Type | Individual
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Provider Name | BRANDON ADAMS
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Gender | Male
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Dates
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Enumeration Date | 04/25/2026
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Last Update Date | 04/25/2026
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Provider Practice Location Address
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Address Line | 525 S MAIN ST
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City | ADA
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State | OH
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Zip | 45810-6000
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Country | US
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Telephone | 419-772-1051
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Fax |
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Provider Business Mailing Address
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Address Line | 6063 TYLER POINT DR
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City | FAIRFIELD TOWNSHIP
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State | OH
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Zip | 45011-2177
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Country | US
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Telephone | 513-607-5529
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 060004257
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License Number State | OH
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