MEDICARE: SIMON ADAMES 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	207R00000X	Internal Medicine Physician	045155	GA
2	207P00000X	Emergency Medicine Physician	45155	GA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	930071441	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	598745	OTHER	GA	BLUE CROSS BLUE SHIELD
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205804622
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SIMON ADAMES MD

Provider Business Mailing Address
First Line	:	3386 GREYSTONE WAY
Second Line	:
City	:	VALDOSTA
State	:	GA
Zip	:	31605-1096
Country	:	US
Telephone Number	:	229-219-7826
Fax Number	:

Provider Business Practice Location Address
First Line	:	3386 GREYSTONE WAY
Second Line	:
City	:	VALDOSTA
State	:	GA
Zip	:	31605-1096
Country	:	US
Telephone Number	:	229-219-7407
Fax Number	:

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

Provider Enumeration Date	:	03/10/2006
Last Update Date	:	11/03/2011

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Directions to “ SIMON ADAMES MD” Practice Location

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