Provider Demographics
NPI:1548722770
Name:TAYLOR, ADAM NAKUMA
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:NAKUMA
Last Name:TAYLOR
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 1:806 UNIVERSAL ST
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37760-2338
Mailing Address - Country:US
Mailing Address - Phone:865-438-0517
Mailing Address - Fax:865-262-0723
Practice Address - Street 1:806 UNIVERSAL ST
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37760-2338
Practice Address - Country:US
Practice Address - Phone:865-438-0517
Practice Address - Fax:865-262-0723
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-05
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNL000000020893253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ015619Medicaid