Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | 5094 | AZ |
Y | 207ND0101X | MOHS-Micrographic Surgeon | 21609 | MS |
NPI | 1396993663 |
---|---|
Provider Name | Dr. Amy Adams |
First Address | Laurel, MS 39441-0247 |
Second Address | Laurel, MS 39440-4243 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/08/2008 |
Last Update Date | 11/02/2014 |