Provider Demographics
NPI:1114925815
Name:KNOWLES, EDWARD WESLEY (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:WESLEY
Last Name:KNOWLES
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 1:911 S BROAD ST
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBORO
Mailing Address - State:AL
Mailing Address - Zip Code:35768-2509
Mailing Address - Country:US
Mailing Address - Phone:256-259-0185
Mailing Address - Fax:256-259-0317
Practice Address - Street 1:911 S BROAD ST
Practice Address - Street 2:
Practice Address - City:SCOTTSBORO
Practice Address - State:AL
Practice Address - Zip Code:35768-2509
Practice Address - Country:US
Practice Address - Phone:256-259-0185
Practice Address - Fax:256-259-0317
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL17019208600000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051555306Medicaid
AL51000144OtherBLUE CROSS
AL051555306Medicaid
515-55306Medicare PIN