Provider Demographics
NPI:1326670928
Name:EDMONSON, BYRON J SR
Entity Type:Individual
Prefix:
First Name:BYRON
Middle Name:J
Last Name:EDMONSON
Suffix:SR
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 1:4641 DREUX AVE
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70126-3509
Mailing Address - Country:US
Mailing Address - Phone:504-710-2006
Mailing Address - Fax:
Practice Address - Street 1:1799 STUMPF BLVD STE 6
Practice Address - Street 2:
Practice Address - City:TERRYTOWN
Practice Address - State:LA
Practice Address - Zip Code:70056-3950
Practice Address - Country:US
Practice Address - Phone:504-301-0811
Practice Address - Fax:504-301-0811
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-11
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator