Provider Demographics
NPI:1962585455
Name:EDWARDS, ALICE L (MD)
Entity type:Individual
Prefix:
First Name:ALICE
Middle Name:L
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 48089
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30604-8089
Mailing Address - Country:US
Mailing Address - Phone:706-389-3727
Mailing Address - Fax:706-389-3951
Practice Address - Street 1:2410 HOG MOUNTAIN RD STE 201
Practice Address - Street 2:
Practice Address - City:WATKINSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30677-4850
Practice Address - Country:US
Practice Address - Phone:706-310-3470
Practice Address - Fax:706-310-9526
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2022-10-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA54647207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAI15635Medicare UPIN
GA08BBRTSMedicare PIN
GAI15635Medicare UPIN