1245453653 NPI number — MR. JAMES D ADAMS D.P.T

Table of content: MR. JAMES D ADAMS D.P.T (NPI 1245453653)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245453653 NPI number — MR. JAMES D ADAMS D.P.T

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ADAMS
Provider First Name:
JAMES
Provider Middle Name:
D
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
D.P.T
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245453653
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/14/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1561 ELLIS RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENVILLE
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
38701-8800
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
662-822-4229
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1561 ELLIS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENVILLE
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
38701-8800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
662-822-4229
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/11/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT2502 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X , with the licence number: PT 2640 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: PT2640 . This is a "AR LIC" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 25383559 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 13831477 . This is a "CAQH" identifier . This identifiers is of the category "OTHER".
  • Identifier: PT2502 . This is a "MS LIC" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
  • Identifier: 524876ZWBL . This is a "PTAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5AB50 . This is a "BCBS" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 149491721 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".




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