Provider Demographics
NPI:1124460514
Name:VAN L. ADAMS M. D., PLLC
Entity type:Organization
Organization Name:VAN L. ADAMS M. D., PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VAN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-751-7665
Mailing Address - Street 1:204 MALLOY ST STE A
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27534-4477
Mailing Address - Country:US
Mailing Address - Phone:919-751-7665
Mailing Address - Fax:919-651-1370
Practice Address - Street 1:204 MALLOY ST STE A
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-4477
Practice Address - Country:US
Practice Address - Phone:919-751-7665
Practice Address - Fax:919-651-1370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-25
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care