Basic Information
| Provider Information | |||||||||
| NPI: | 1043291123 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ADAMS | ||||||||
| FirstName: | DOUGLAS | ||||||||
| MiddleName: | W | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1643 SLAUGHTER RD | ||||||||
| Address2: | |||||||||
| City: | MADISON | ||||||||
| State: | AL | ||||||||
| PostalCode: | 357588692 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2568958148 | ||||||||
| FaxNumber: | 2564898148 | ||||||||
| Practice Location | |||||||||
| Address1: | 4040 MEMORIAL PKWY SW | ||||||||
| Address2: | |||||||||
| City: | HUNTSVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 358024364 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2565331970 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/07/2005 | ||||||||
| LastUpdateDate: | 06/27/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 22646 | AL | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 51541121 | 01 | AL | BCBS | OTHER | 331300666 | 05 | AL | MEDICAID | 330000014 | 05 | AL | MEDICAID | 51527008 | 01 | AL | BLUE CROSS BLUE SHIELD | OTHER | 51527345 | 01 | AL | FEDERAL BLUE CROSS PROGRA | OTHER |