=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750381612
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | THOMAS VINCENT ADAMKIEWICZ MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/21/2005
-----------------------------------------------------
Last Update Date | 03/18/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3020 MERCER UNIVERSITY DR
-----------------------------------------------------
City | CHAMBLEE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30341-4145
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-458-3383
-----------------------------------------------------
Fax | 770-458-9958
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3020 MERCER UNIVERSITY DR STE 100
-----------------------------------------------------
City | CHAMBLEE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30341-4145
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-458-3383
-----------------------------------------------------
Fax | 770-458-9958
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2080P0207X
-----------------------------------------------------
Taxonomy Name | Pediatric Hematology & Oncology Physician
-----------------------------------------------------
License Number | 40851
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | 40851
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------