Provider Demographics
NPI:1740143221
Name:EDWARDS, JOHN WILLIAM III
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:WILLIAM
Last Name:EDWARDS
Suffix:III
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 1:7918 EL CAJON BLVD STE N
Mailing Address - Street 2:#113
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-6710
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7918 EL CAJON BLVD STE N
Practice Address - Street 2:#113
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-6710
Practice Address - Country:US
Practice Address - Phone:619-891-2887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-12-03
Last Update Date:2025-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1329321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical