Provider Demographics
NPI:1427082726
Name:ADAMS, TIMOTHY (DPM)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:ADAMS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 HOSPITAL CIR
Mailing Address - Street 2:
Mailing Address - City:CHOCTAW
Mailing Address - State:MS
Mailing Address - Zip Code:39350-6781
Mailing Address - Country:US
Mailing Address - Phone:601-389-4500
Mailing Address - Fax:601-663-7721
Practice Address - Street 1:210 HOSPITAL CIR
Practice Address - Street 2:
Practice Address - City:CHOCTAW
Practice Address - State:MS
Practice Address - Zip Code:39350-6781
Practice Address - Country:US
Practice Address - Phone:601-389-4500
Practice Address - Fax:601-663-7721
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2015-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS80139213E00000X
IN07001039A213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200861050Medicaid
INP01192556OtherRAILROAD MEDICARE
IN000000543884OtherANTHEM
MS01270333Medicaid
IN200861050Medicaid
KYK043691Medicare PIN
INP00417651Medicare PIN
INP01192556OtherRAILROAD MEDICARE
MS480000135Medicare ID - Type Unspecified