MEDICARE: DR. WILLIE ADAMS, JR. M.D.

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	207VG0400X	Gynecology Physician	013004	GA

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

General Provider Information

NPI Number	:	1447335856
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIE ADAMS, JR. M.D.

Provider Business Mailing Address
First Line	:	PO BOX 1510
Second Line	:
City	:	CAIRO
State	:	GA
Zip	:	39828-0970
Country	:	US
Telephone Number	:	229-397-9355
Fax Number	:

Provider Business Practice Location Address
First Line	:	195 MARTIN LUTHER KING JR AVE SW
Second Line	:
City	:	CAIRO
State	:	GA
Zip	:	39828-2605
Country	:	US
Telephone Number	:	229-439-7721
Fax Number	:

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

Provider Enumeration Date	:	10/25/2006
Last Update Date	:	08/03/2020

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