Provider Demographics
NPI:1295758597
Name:EDWARDS, MIRANDA Y (MD)
Entity type:Individual
Prefix:DR
First Name:MIRANDA
Middle Name:Y
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4173
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31914-0173
Mailing Address - Country:US
Mailing Address - Phone:706-243-2900
Mailing Address - Fax:706-243-2903
Practice Address - Street 1:500 18TH ST
Practice Address - Street 2:SUITE A-10
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31901-1536
Practice Address - Country:US
Practice Address - Phone:706-243-2900
Practice Address - Fax:706-243-2903
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2011-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA049971207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000926043CMedicaid
GA08BBRPKMedicare ID - Type Unspecified
GA000926043CMedicaid