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General NPI Number Information
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NPI Number | 1831395052
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Entity Type | Individual
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Provider Name | STEPHEN RANDALL ADCOCK MD
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Gender | Male
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Dates
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Enumeration Date | 06/25/2007
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Last Update Date | 05/24/2016
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Provider Practice Location Address
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Address Line | 2002 ALICE ST
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City | WAYCROSS
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State | GA
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Zip | 31501-6210
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Country | US
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Telephone | 912-283-8444
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 173
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City | WAYCROSS
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State | GA
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Zip | 31502-0173
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Country | US
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Telephone | 912-283-8444
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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 | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 21934
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 282871
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License Number State | NY
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