Provider Demographics
NPI:1356458947
Name:CARL EDWARDS, MD, PLC
Entity Type:Organization
Organization Name:CARL EDWARDS, MD, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARSHA
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:SPEAKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-268-9727
Mailing Address - Street 1:505 E MATTHEWS AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-3101
Mailing Address - Country:US
Mailing Address - Phone:870-268-9727
Mailing Address - Fax:870-268-9744
Practice Address - Street 1:505 E MATTHEWS AVE STE 203
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-3101
Practice Address - Country:US
Practice Address - Phone:870-268-9727
Practice Address - Fax:870-268-9744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR4353174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR123296001Medicaid
AR5J094Medicare ID - Type Unspecified
AR123296001Medicaid