Provider Demographics
NPI:1730421652
Name:ADAMS, CLINTON JAMES (PA-C)
Entity type:Individual
Prefix:MR
First Name:CLINTON
Middle Name:JAMES
Last Name:ADAMS
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:PO BOX 79777 102
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21279-0777
Mailing Address - Country:US
Mailing Address - Phone:540-689-5600
Mailing Address - Fax:757-579-8532
Practice Address - Street 1:2006 HEALTH CAMPUS DR
Practice Address - Street 2:
Practice Address - City:ROCKINGHAM
Practice Address - State:VA
Practice Address - Zip Code:22801-8679
Practice Address - Country:US
Practice Address - Phone:540-689-5600
Practice Address - Fax:757-579-8532
Is Sole Proprietor?:No
Enumeration Date:2013-03-18
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0110004182363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1730421652Medicaid