Provider Demographics
NPI:1780476499
Name:ADKISSON, JEFFREY THOMAS JR
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:THOMAS
Last Name:ADKISSON
Suffix:JR
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 1:1555 FOXLEIGH CT
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63131-1229
Mailing Address - Country:US
Mailing Address - Phone:314-917-1738
Mailing Address - Fax:
Practice Address - Street 1:1555 FOXLEIGH CT
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63131-1229
Practice Address - Country:US
Practice Address - Phone:314-917-1738
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-19
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program