Provider Demographics
NPI:1992355523
Name:EDWARDS, TIMOTHY MARCUS
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:MARCUS
Last Name:EDWARDS
Suffix:
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 1:2795 TOWNSHIP ROAD 223
Mailing Address - Street 2:
Mailing Address - City:ASHLEY
Mailing Address - State:OH
Mailing Address - Zip Code:43003-9763
Mailing Address - Country:US
Mailing Address - Phone:614-323-5007
Mailing Address - Fax:
Practice Address - Street 1:2560 BILLINGSLEY RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43235-1990
Practice Address - Country:US
Practice Address - Phone:614-407-2018
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-16
Last Update Date:2019-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator