Provider Demographics
NPI:1215625025
Name:ARLT, ADAM B
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:B
Last Name:ARLT
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 1:550 HARBOR COVE LN APT 1200A
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29412-3012
Mailing Address - Country:US
Mailing Address - Phone:706-614-9715
Mailing Address - Fax:
Practice Address - Street 1:1154 MAIN ST
Practice Address - Street 2:
Practice Address - City:PORTERDALE
Practice Address - State:GA
Practice Address - Zip Code:30014-3440
Practice Address - Country:US
Practice Address - Phone:706-614-9715
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-28
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN268436163WC0200X, 367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine