Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | 1799 | WV |
NPI | 1326128083 |
---|---|
Provider Name | Dr. Jimmy Wayne Adams |
First Address | Barboursville, WV 25504-0328 |
Second Address | Barboursville, WV 25504-1042 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2006 |
Last Update Date | 09/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G19214 | (02) |