Provider Demographics
NPI:1205011087
Name:EDWARDS, JESSICA AGATHA (MD)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:AGATHA
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DOBSON
Mailing Address - State:NC
Mailing Address - Zip Code:27017-8593
Mailing Address - Country:US
Mailing Address - Phone:336-985-0625
Mailing Address - Fax:
Practice Address - Street 1:202 SCENIC DR
Practice Address - Street 2:
Practice Address - City:KING
Practice Address - State:NC
Practice Address - Zip Code:27021-9418
Practice Address - Country:US
Practice Address - Phone:336-985-0625
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-30
Last Update Date:2020-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC93-008382084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry