Provider Demographics
NPI:1033186648
Name:BYNE, EDMUND GORDON (MD)
Entity Type:Individual
Prefix:
First Name:EDMUND
Middle Name:GORDON
Last Name:BYNE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2467 GOLDEN CAMP RD
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30906-5515
Mailing Address - Country:US
Mailing Address - Phone:706-790-4440
Mailing Address - Fax:
Practice Address - Street 1:480 MARTIN LUTHER KING RD LOT B
Practice Address - Street 2:
Practice Address - City:KEYSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30816-4464
Practice Address - Country:US
Practice Address - Phone:762-994-0902
Practice Address - Fax:762-994-0907
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA024786207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA145149011AMedicaid
D44983Medicare UPIN