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Individual

MRS. GWENDOLYN ELEANOR ADAMS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
101 IVORY PL, MADISON, AL 35758-2349
(256) 325-0236
(256) 993-3133
Mailing address
101 IVORY PL, MADISON, AL 35758-2349
(256) 325-0236
(256) 993-3133

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA 847
AL
363AM0700X
Medical Physician Assistant
Primary
PA.847
AL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
011846
MAIN GROUP MEDICARE NUMBER
AL
01
1063439065
MAIN GROUP NPI PAYEE NUMBER
AL
05
630000013
AL
Enumeration date
10/16/2012
Last updated
08/07/2025
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