Provider Demographics
NPI:1962402347
Name:EDWARDS, WILLIAM CARLTON SR (OD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:CARLTON
Last Name:EDWARDS
Suffix:SR
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3629 KIMBROUGH PT
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30135-1937
Mailing Address - Country:US
Mailing Address - Phone:770-942-7675
Mailing Address - Fax:
Practice Address - Street 1:3417 HIGHWAY 5
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-2378
Practice Address - Country:US
Practice Address - Phone:770-949-2020
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1099-T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA41ZCDQSMedicare ID - Type Unspecified
GAT97556Medicare UPIN