=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649230970
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ADRINE SUE ADAMS CRNA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/23/2006
-----------------------------------------------------
Last Update Date | 02/12/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | ONE HOSPITAL DR
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 65212-0001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 573-882-2568
-----------------------------------------------------
Fax | 855-903-0985
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 2564
-----------------------------------------------------
City | MACON
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31203-2564
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 478-746-5644
-----------------------------------------------------
Fax | 478-745-4849
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 367500000X
-----------------------------------------------------
Taxonomy Name | Certified Registered Nurse Anesthetist
-----------------------------------------------------
License Number | R044170
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 367500000X
-----------------------------------------------------
Taxonomy Name | Certified Registered Nurse Anesthetist
-----------------------------------------------------
License Number | 2023050141
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------