Provider Demographics
NPI:1699884957
Name:ADAM, MICHAEL (PA)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:ADAM
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3587 EVANS TO LOCKS RD
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:GA
Mailing Address - Zip Code:30907-4909
Mailing Address - Country:US
Mailing Address - Phone:706-869-1024
Mailing Address - Fax:
Practice Address - Street 1:1168 W MARTINTOWN RD
Practice Address - Street 2:
Practice Address - City:NORTH AUGUSTA
Practice Address - State:SC
Practice Address - Zip Code:29841-2046
Practice Address - Country:US
Practice Address - Phone:803-202-0053
Practice Address - Fax:803-202-0018
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA004142363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC0137PAMedicaid
GA124275211AMedicaid
SCP00688379OtherRAIL ROAD MEDICARE
SCAA35041680Medicare PIN
P99312Medicare UPIN
GA97WCFCFMedicare ID - Type UnspecifiedGA MCARE