Provider Demographics
NPI:1487530614
Name:EDWARDS, TRAY DANNIE MARQUIS JR
Entity type:Individual
Prefix:
First Name:TRAY
Middle Name:DANNIE MARQUIS
Last Name:EDWARDS
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2362 VENDOME DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43219-1427
Mailing Address - Country:US
Mailing Address - Phone:614-745-7624
Mailing Address - Fax:
Practice Address - Street 1:2362 VENDOME DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43219-1427
Practice Address - Country:US
Practice Address - Phone:614-745-7624
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-13
Last Update Date:2025-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant