Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | 045452 | GA |
NPI | 1205822814 |
---|---|
Provider Name | Dr. Michael Scott Edwards |
First Address | Albany, GA 31702-2548 |
Second Address | Albany, GA 31701-1943 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2005 |
Last Update Date | 17/11/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000794318A | (05) | GA |
E85398 | (02) | GA |