Provider Demographics
NPI:1306608377
Name:EDWARDS, AUTUMN DENISE
Entity type:Individual
Prefix:
First Name:AUTUMN
Middle Name:DENISE
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:283 UNION CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:LUCEDALE
Mailing Address - State:MS
Mailing Address - Zip Code:39452-6203
Mailing Address - Country:US
Mailing Address - Phone:601-770-3651
Mailing Address - Fax:
Practice Address - Street 1:283 UNION CHURCH RD
Practice Address - Street 2:
Practice Address - City:LUCEDALE
Practice Address - State:MS
Practice Address - Zip Code:39452-6203
Practice Address - Country:US
Practice Address - Phone:601-770-3651
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-25
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program