Basic Information
Provider Information
NPI: 1669600235
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HOOVER
FirstName: ADAM
MiddleName: FERREL
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1499 WALTON WAY
Address2: STE 1400
City: AUGUSTA
State: GA
PostalCode: 309012602
CountryCode: US
TelephoneNumber: 7067246100
FaxNumber:  
Practice Location
Address1: 1120 15TH ST
Address2:  
City: AUGUSTA
State: GA
PostalCode: 309120004
CountryCode: US
TelephoneNumber: 7067210211
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/23/2009
LastUpdateDate: 09/30/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000X003554GAY Allopathic & Osteopathic PhysiciansInternal Medicine 

No ID Information.


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