Provider Demographics
NPI:1114038205
Name:EDWARDS, ALAN W (MD)
Entity Type:Individual
Prefix:MR
First Name:ALAN
Middle Name:W
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 755
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:VA
Mailing Address - Zip Code:23851
Mailing Address - Country:US
Mailing Address - Phone:757-562-4196
Mailing Address - Fax:757-562-0065
Practice Address - Street 1:100 FAIRVIEW DR
Practice Address - Street 2:SUITE 101 SOUTHAMPTON MEDICAL BLDG
Practice Address - City:FRANKLIN
Practice Address - State:VA
Practice Address - Zip Code:23851
Practice Address - Country:US
Practice Address - Phone:757-562-4196
Practice Address - Fax:757-562-0065
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101026338207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6070051Medicaid
003055OtherBCBS
VA6070051Medicaid