Basic Information
| Provider Information | |||||||||
| NPI: | 1497940753 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ADAMS | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | DERRICK | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 740 E LAUREL RD | ||||||||
| Address2: | |||||||||
| City: | LONDON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 407418601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6063303404 | ||||||||
| FaxNumber: | 6063302369 | ||||||||
| Practice Location | |||||||||
| Address1: | 1406 W 5TH ST | ||||||||
| Address2: | STE 201 | ||||||||
| City: | LONDON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 407411688 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6063302377 | ||||||||
| FaxNumber: | 6063302369 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/10/2007 | ||||||||
| LastUpdateDate: | 09/25/2017 | ||||||||
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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 | 207P00000X | 43263 | KY | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207Q00000X | 43263 | KY | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 7100102930 | 05 | KY | MEDICAID |