Provider Demographics
NPI:1063220036
Name:ADAWY, MAIN
Entity type:Individual
Prefix:
First Name:MAIN
Middle Name:
Last Name:ADAWY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:485 ENSWORTH CT APT 302
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-2220
Mailing Address - Country:US
Mailing Address - Phone:901-605-6959
Mailing Address - Fax:
Practice Address - Street 1:5389 AIRLINE RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TN
Practice Address - Zip Code:38002-4266
Practice Address - Country:US
Practice Address - Phone:901-209-4978
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-23
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN36705363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily