MEDICARE: CECILIA D ADAMS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	32134	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	4091779	OTHER	TN	BLUE CROSS BLUE SHIELD
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104823020
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CECILIA D ADAMS MD

Provider Business Mailing Address
First Line	:	6637 SUMMER KNOLL CIR
Second Line	:	SUITE 101
City	:	BARTLETT
State	:	TN
Zip	:	38134-2875
Country	:	US
Telephone Number	:	901-372-5260
Fax Number	:	901-386-8726

Provider Business Practice Location Address
First Line	:	6637 SUMMER KNOLL CIR
Second Line	:	SUITE 101
City	:	BARTLETT
State	:	TN
Zip	:	38134-2875
Country	:	US
Telephone Number	:	901-372-5260
Fax Number	:	901-386-8726

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	04/05/2012

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