Basic Information
| Provider Information | |||||||||
| NPI: | 1457731028 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ADAMS | ||||||||
| FirstName: | MITCHELL | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 445 GULF SHORE DR | ||||||||
| Address2: | UNIT 5 | ||||||||
| City: | DESTIN | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325415005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4074030434 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1370 W D ST | ||||||||
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| City: | NORTH WILKESBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286593506 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3366518100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2015 | ||||||||
| LastUpdateDate: | 06/09/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.