Provider Demographics
NPI:1114960762
Name:EDWARDS, ANDREA K (NP)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:K
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1602 DRAYTON ST
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31401-7526
Mailing Address - Country:US
Mailing Address - Phone:912-651-3378
Mailing Address - Fax:912-651-2588
Practice Address - Street 1:1602 DRAYTON ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31401-7526
Practice Address - Country:US
Practice Address - Phone:912-651-3378
Practice Address - Fax:912-651-2588
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN032774363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA97BBDPZMedicare ID - Type UnspecifiedNP