Provider Demographics
NPI:1720072317
Name:EDWARDS, JAMES BENNETT (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:BENNETT
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 E DERENNE AVE
Mailing Address - Street 2:ATTN: PROVIDER ENROLLMENT
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-6736
Mailing Address - Country:US
Mailing Address - Phone:912-644-5300
Mailing Address - Fax:912-644-5260
Practice Address - Street 1:503 EISENHOWER DR
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406
Practice Address - Country:US
Practice Address - Phone:912-355-6255
Practice Address - Fax:912-644-5260
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0417842085B0100X, 2085N0700X, 2085N0904X, 2085P0229X, 2085U0001X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear Radiology
No2085P0229XAllopathic & Osteopathic PhysiciansRadiologyPediatric Radiology
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000702039Medicaid
SCG41784-SRMedicaid
GAP00334794OtherRAILROAD MEDICARE-SCI
GAP00857151OtherRR MCARE-OIS
GA010571OtherBCBS GA
SCG042726289Medicare ID - Type UnspecifiedMEDICARE SC
GA010571OtherBCBS GA
GAP00334794OtherRAILROAD MEDICARE-SCI
GAP00857151OtherRR MCARE-OIS
GA2023I09984-OIS METROMedicare PIN
SCG41784-SRMedicaid
GA202I307913-OISMedicare PIN