Provider Demographics
NPI:1336135029
Name:EDWARDS, STEVEN E (CRNA)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:E
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:CRNA
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:131 TUCKER ST
Mailing Address - Street 2:STE 5 PROFESSIONAL ANESTHESIA ASSOCIATES
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38301-4055
Mailing Address - Country:US
Mailing Address - Phone:931-388-6404
Mailing Address - Fax:931-388-7119
Practice Address - Street 1:131 TUCKER ST
Practice Address - Street 2:STE 5 PROFESSIONAL ANESTHESIA ASSOCIATES
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38301-4055
Practice Address - Country:US
Practice Address - Phone:931-388-6404
Practice Address - Fax:931-388-7119
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNRN71433207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3609080Medicaid
TN3609082Medicare ID - Type Unspecified