Provider Demographics
NPI:1326314089
Name:EDWARDS, DEREK
Entity Type:Individual
Prefix:
First Name:DEREK
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 TOOMER ST STE B
Mailing Address - Street 2:
Mailing Address - City:OPELIKA
Mailing Address - State:AL
Mailing Address - Zip Code:36801-7335
Mailing Address - Country:US
Mailing Address - Phone:334-363-0259
Mailing Address - Fax:334-363-0255
Practice Address - Street 1:1600 TOOMER ST STE B
Practice Address - Street 2:
Practice Address - City:OPELIKA
Practice Address - State:AL
Practice Address - Zip Code:36801-7335
Practice Address - Country:US
Practice Address - Phone:334-363-0259
Practice Address - Fax:334-363-0255
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-27
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator