MEDICARE: THOMAS VINCENT ADAMKIEWICZ 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	2080P0207X	Pediatric Hematology & Oncology Physician	40851	GA
2	208000000X	Pediatrics Physician	40851	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1750381612
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS VINCENT ADAMKIEWICZ MD

Provider Business Mailing Address
First Line	:	3020 MERCER UNIVERSITY DR
Second Line	:	STE 100
City	:	CHAMBLEE
State	:	GA
Zip	:	30341-4145
Country	:	US
Telephone Number	:	770-458-3383
Fax Number	:	770-458-9958

Provider Business Practice Location Address
First Line	:	3020 MERCER UNIVERSITY DR
Second Line	:
City	:	CHAMBLEE
State	:	GA
Zip	:	30341-4145
Country	:	US
Telephone Number	:	770-458-3383
Fax Number	:	770-458-9958

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

Provider Enumeration Date	:	07/21/2005
Last Update Date	:	03/18/2019

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