Provider Demographics
NPI:1184632549
Name:EDWARDS, JOHN A (PHD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:A
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:607 IDOL ST
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27262-7804
Mailing Address - Country:US
Mailing Address - Phone:336-802-2407
Mailing Address - Fax:336-802-2401
Practice Address - Street 1:721 N ELM ST
Practice Address - Street 2:SUITE 101
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27262-3928
Practice Address - Country:US
Practice Address - Phone:336-802-2205
Practice Address - Fax:336-802-2599
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC23103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC23OtherLICENSE NUMBER
NC6000901Medicaid
NC6000901Medicaid