Provider Demographics
NPI:1972856995
Name:ADAMS, GWENDOLYN ELEANOR (PA-C)
Entity type:Individual
Prefix:MRS
First Name:GWENDOLYN
Middle Name:ELEANOR
Last Name:ADAMS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:GWENDOLYN
Other - Middle Name:ELEANOR
Other - Last Name:DAY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:101 IVORY PL
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-2349
Mailing Address - Country:US
Mailing Address - Phone:256-325-0236
Mailing Address - Fax:256-993-3133
Practice Address - Street 1:101 IVORY PL
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-2349
Practice Address - Country:US
Practice Address - Phone:256-325-0236
Practice Address - Fax:256-993-3133
Is Sole Proprietor?:No
Enumeration Date:2012-10-16
Last Update Date:2025-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPA.847363AM0700X
ALPA 847363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL011846OtherMAIN GROUP MEDICARE NUMBER
AL1063439065OtherMAIN GROUP NPI PAYEE NUMBER
AL630000013Medicaid