Basic Information
| Provider Information | |||||||||
| NPI: | 1568420628 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ADAMS | ||||||||
| FirstName: | JON | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5500 COUNTY ROAD 37 | ||||||||
| Address2: | |||||||||
| City: | TROY | ||||||||
| State: | AL | ||||||||
| PostalCode: | 360818127 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3346702122 | ||||||||
| FaxNumber: | 3346702103 | ||||||||
| Practice Location | |||||||||
| Address1: | 5500 COUNTY ROAD 37 | ||||||||
| Address2: | |||||||||
| City: | TROY | ||||||||
| State: | AL | ||||||||
| PostalCode: | 360818127 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3346702122 | ||||||||
| FaxNumber: | 3346702103 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/01/2006 | ||||||||
| LastUpdateDate: | 04/04/2019 | ||||||||
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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 | 363A00000X | PA.154 | AL | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 207R00000X | PA-154 | AL | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 000044791 | 05 | AL | MEDICAID | 051044791 | 01 | AL | BLUE CROSS NUMBER | OTHER | 1568420628 | 01 | AL | NPI | OTHER |