Provider Demographics
NPI:1861224784
Name:ADAMS, ANTWAN
Entity type:Individual
Prefix:
First Name:ANTWAN
Middle Name:
Last Name:ADAMS
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 1:4803 RED BRUSH DR
Mailing Address - Street 2:
Mailing Address - City:MC LEANSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27301-9314
Mailing Address - Country:US
Mailing Address - Phone:252-258-4783
Mailing Address - Fax:
Practice Address - Street 1:201 E 5TH ST STE 1900
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45202-4162
Practice Address - Country:US
Practice Address - Phone:252-258-4783
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-19
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator