Basic Information
| Provider Information | |||||||||
| NPI: | 1326328303 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HUMPHREY | ||||||||
| FirstName: | ADAM | ||||||||
| MiddleName: | ISAAC | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 979 E 3RD ST STE C735 | ||||||||
| Address2: | |||||||||
| City: | CHATTANOOGA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 374033310 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4237789101 | ||||||||
| FaxNumber: | 4237789190 | ||||||||
| Practice Location | |||||||||
| Address1: | 979 E 3RD ST STE C735 | ||||||||
| Address2: | |||||||||
| City: | CHATTANOOGA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 374033310 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4237789101 | ||||||||
| FaxNumber: | 4237789190 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/23/2011 | ||||||||
| LastUpdateDate: | 02/01/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/27/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA1992 | ME | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363A00000X | GA | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363A00000X | 2177 | TN | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363AM0700X | 2177 | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.