Provider Demographics
NPI:1326001686
Name:EDWARDS, BUFORD OTTO JR (MD)
Entity Type:Individual
Prefix:DR
First Name:BUFORD
Middle Name:OTTO
Last Name:EDWARDS
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:2410 HOG MOUNTAIN RD
Mailing Address - Street 2:ST 307
Mailing Address - City:WATKINSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30677-4811
Mailing Address - Country:US
Mailing Address - Phone:706-769-7911
Mailing Address - Fax:706-769-0826
Practice Address - Street 1:760 26TH AVE SE
Practice Address - Street 2:
Practice Address - City:MOULTRIE
Practice Address - State:GA
Practice Address - Zip Code:31768-6799
Practice Address - Country:US
Practice Address - Phone:229-985-1457
Practice Address - Fax:229-890-9430
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-08
Last Update Date:2023-01-25
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Provider Licenses
StateLicense IDTaxonomies
GA028160208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000411507AMedicaid