Individual
ADAM DEAN MICKEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
2242 W ROOSEVELT BLVD STE A, MONROE, NC 28110
(704) 220-1904
Mailing address
2242 W ROOSEVELT BLVD STE A, MONROE, NC 28110-3071
(704) 220-1904
(704) 776-9495
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0010-07049
NC
363AM0700X
Medical Physician Assistant
0010-07049
NC
363AS0400X
Surgical Physician Assistant
PA9108348
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003156207A
—
GA
05
—
013627200
—
FL
Enumeration date
10/17/2014
Last updated
06/10/2024
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