Edwards, Jerry L

Edwards, Jerry L is an individual health care provider with primary practice located at 3412 Staunton Ave Se , Charleston WV 25304-1327. He recently has only one registered license in Allopathic & Osteopathic Physicians / Emergency Medicine, which is considered as his primary health care specialty. Edwards, Jerry L can be contacted via phone (304) 388-6004.

Contact Information

Primary practice address
3412 Staunton Ave Se Charleston WV 25304-1327
Phone: (304) 388-6004
Fax: (304) 388-3360
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Emergency Medicine 207P00000X DO1265 Tennessee
Allopathic & Osteopathic Physicians / Emergency Medicine 207P00000X 851 West Virginia

Profile Details

NPI number 1457321820
LBN Legal business name Edwards, Jerry L
Credentials Doctor of Osteopathy (DO)
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 26th, 2006
Last updated Oct 19th, 2018 - about 8 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1457321820 NPPES
Tennessee MEDICAID 3305715
Tennessee Other 4078407
Tennessee Other 930077458

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