Provider Demographics
NPI:1962469023
Name:ADAMS, JOHN ROBERT JR (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:ROBERT
Last Name:ADAMS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1325 WOLF PARK DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-1742
Mailing Address - Country:US
Mailing Address - Phone:901-252-3411
Mailing Address - Fax:901-763-4305
Practice Address - Street 1:1325 WOLF PARK DR
Practice Address - Street 2:SUITE 102
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-1742
Practice Address - Country:US
Practice Address - Phone:901-252-3400
Practice Address - Fax:901-763-4305
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2016-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN16559208800000X, 208800000X
MS15870208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0108491OtherTENNCARE SELECT
2598232OtherCIGNA
02110025800OtherQUAL CHOICE
13023659OtherHEALTH ASSURANCE EPA
13023659OtherPHCS
FIRST HEALTHOther833190
211159OtherSOUTHERN HEALTH SERVICES
TN0108491OtherBLUE CROSS
3050118OtherTENNCARE (ALL OTHER PLANS
TN3050118Medicaid
274456OtherHEALTHLINK
4131368OtherAETNA
AR97432OtherBLUE CROSS AR
274456OtherHEALTHLINK
AR97432OtherBLUE CROSS AR
13023659OtherHEALTH ASSURANCE EPA
0108491OtherTENNCARE SELECT