Provider Demographics
NPI:1215937594
Name:ADAMS, CHARLES MORRIS
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:MORRIS
Last Name:ADAMS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:MORRIE
Other - Middle Name:
Other - Last Name:ADAMS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LISW
Mailing Address - Street 1:320 KIRKWOOD AVE
Mailing Address - Street 2:P.O. BOX 2147
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52240-4754
Mailing Address - Country:US
Mailing Address - Phone:319-351-6654
Mailing Address - Fax:
Practice Address - Street 1:320 KIRKWOOD AVE
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52240-4754
Practice Address - Country:US
Practice Address - Phone:319-351-6654
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA000511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA01871OtherBLUE CROSS/ BLUE SHIELD O
IA421501340YIR3P8Medicaid
IAI10772Medicare ID - Type Unspecified