Provider Demographics
NPI:1346225489
Name:EDWARDS, BRENT S (MD)
Entity Type:Individual
Prefix:DR
First Name:BRENT
Middle Name:S
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3614 J DEWEY GRAY CIR STE A
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-6512
Mailing Address - Country:US
Mailing Address - Phone:706-922-9222
Mailing Address - Fax:706-922-5766
Practice Address - Street 1:3614 J DEWEY GRAY CIR STE A
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-6512
Practice Address - Country:US
Practice Address - Phone:706-922-9222
Practice Address - Fax:706-922-5766
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2011-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA039781174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist