Basic Information
Provider Information
NPI: 1891874939
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ADAMS
FirstName: CORNELIA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: CRNA
OtherOrganizationName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 8846
Address2:  
City: GREENSBORO
State: NC
PostalCode: 274190846
CountryCode: US
TelephoneNumber: 3365531659
FaxNumber:  
Practice Location
Address1: 4280 N VALDOSTA RD
Address2: DEPT OF ANESTHESIA
City: VALDOSTA
State: GA
PostalCode: 316026814
CountryCode: US
TelephoneNumber: 2296712066
FaxNumber: 3365533994
Other Information
ProviderEnumerationDate: 11/02/2006
LastUpdateDate: 04/17/2008
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
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AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
367500000XRN088534GAY Physician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered 

No ID Information.


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