Provider Demographics
NPI:1154625754
Name:EDWARDS, ALICE WHITTAKER (RD)
Entity type:Individual
Prefix:
First Name:ALICE
Middle Name:WHITTAKER
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1955 UNION PL APT C50
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401-5906
Mailing Address - Country:US
Mailing Address - Phone:931-698-9726
Mailing Address - Fax:
Practice Address - Street 1:861 W JAMES CAMPBELL BLVD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-4668
Practice Address - Country:US
Practice Address - Phone:931-698-9726
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-22
Last Update Date:2010-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLDN 2151133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered