Provider Demographics
NPI:1033187356
Name:EDWARDS, TOM N (MD)
Entity Type:Individual
Prefix:DR
First Name:TOM
Middle Name:N
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:THOMAS
Other - Middle Name:N
Other - Last Name:EDWARDS
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:4614 CARNEGIE AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:AL
Mailing Address - Zip Code:35064-1430
Mailing Address - Country:US
Mailing Address - Phone:205-785-1353
Mailing Address - Fax:205-785-3731
Practice Address - Street 1:4614 CARNEGIE AVE
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:AL
Practice Address - Zip Code:35064-1430
Practice Address - Country:US
Practice Address - Phone:205-785-1353
Practice Address - Fax:205-785-3731
Is Sole Proprietor?:No
Enumeration Date:2006-03-11
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL9313207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL0112865OtherUNITED HEALTH CARE
ALP00139033OtherRAILROAD MCARE
AL009902185Medicaid
AL009902185Medicaid
AL0112865OtherUNITED HEALTH CARE