Provider Demographics
NPI:1346244951
Name:EDWARDS, JAMES BRYANT III (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:BRYANT
Last Name:EDWARDS
Suffix:III
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 1:1306 N FRASER ST
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:SC
Mailing Address - Zip Code:29440-2800
Mailing Address - Country:US
Mailing Address - Phone:843-546-3132
Mailing Address - Fax:843-546-2268
Practice Address - Street 1:1306 N FRASER ST
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:SC
Practice Address - Zip Code:29440-2800
Practice Address - Country:US
Practice Address - Phone:843-546-3132
Practice Address - Fax:843-546-2268
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2010-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5875174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC058751Medicaid
SC1346244951OtherNPI
SC201203904OtherTAX ID
SCC61185Medicare UPIN
SC058751Medicaid