Provider Demographics
NPI:1376739151
Name:EDMOND, DAVISSON JEAN LEANDRE F E (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVISSON
Middle Name:JEAN LEANDRE F E
Last Name:EDMOND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:671 SNOW ST
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:AL
Mailing Address - Zip Code:36203-1212
Mailing Address - Country:US
Mailing Address - Phone:256-770-4750
Mailing Address - Fax:256-770-4031
Practice Address - Street 1:671 SNOW ST
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:AL
Practice Address - Zip Code:36203-1212
Practice Address - Country:US
Practice Address - Phone:256-770-4750
Practice Address - Fax:256-770-4032
Is Sole Proprietor?:No
Enumeration Date:2007-09-14
Last Update Date:2016-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL30459207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL168070Medicaid
AL168070Medicaid
AL10208I2223Medicare PIN