Basic Information
| Provider Information | |||||||||
| NPI: | 1093071144 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ADAMS-HARRISON | ||||||||
| FirstName: | ANGELA | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1245 PEACHCREEK RD | ||||||||
| Address2: | |||||||||
| City: | DAYTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454583263 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9374331001 | ||||||||
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| Practice Location | |||||||||
| Address1: | 415 BYERS ROAD SUITE 300 | ||||||||
| Address2: | |||||||||
| City: | MIAMISBURG | ||||||||
| State: | OH | ||||||||
| PostalCode: | 453423263 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9378662494 | ||||||||
| FaxNumber: | 9378668494 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/03/2012 | ||||||||
| LastUpdateDate: | 11/13/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 11/13/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 35.127452 | OH | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0129627 | 05 | OH | MEDICAID |