Provider Demographics
NPI:1336135268
Name:MILLER EDMONSON, BRENDA C (MD)
Entity Type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:C
Last Name:MILLER EDMONSON
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:910 ADAMS ST SE
Mailing Address - Street 2:SUITE 130
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-3730
Mailing Address - Country:US
Mailing Address - Phone:256-265-6344
Mailing Address - Fax:256-265-7965
Practice Address - Street 1:910 ADAMS ST SE
Practice Address - Street 2:SUITE 130
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-3730
Practice Address - Country:US
Practice Address - Phone:256-265-6344
Practice Address - Fax:256-265-7965
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-26
Last Update Date:2013-10-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AL26946207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL32640OtherMEDICARE ID
H81403Medicare UPIN