Basic Information
| Provider Information | |||||||||
| NPI: | 1356364459 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ADKISSON | ||||||||
| FirstName: | JIMMY | ||||||||
| MiddleName: | WAYNE | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 648 | ||||||||
| Address2: | |||||||||
| City: | BREWTON | ||||||||
| State: | AL | ||||||||
| PostalCode: | 364270648 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2518676071 | ||||||||
| FaxNumber: | 2518675999 | ||||||||
| Practice Location | |||||||||
| Address1: | 1121 BELLEVILLE AVE | ||||||||
| Address2: | |||||||||
| City: | BREWTON | ||||||||
| State: | AL | ||||||||
| PostalCode: | 364261500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2518676071 | ||||||||
| FaxNumber: | 2518675999 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 207Q00000X | DO59 | AL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.