=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740394873
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANTOINETTE D ADAMS DPM
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/18/2006
-----------------------------------------------------
Last Update Date | 03/09/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 137 BAKER ST
-----------------------------------------------------
City | EMPORIA
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23847-1703
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 434-336-9001
-----------------------------------------------------
Fax | 434-336-9229
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 306
-----------------------------------------------------
City | EMPORIA
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23847
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 434-336-9001
-----------------------------------------------------
Fax | 434-336-9229
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213E00000X
-----------------------------------------------------
Taxonomy Name | Podiatrist
-----------------------------------------------------
License Number | 0103300897
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------