Provider Demographics
NPI:1407220718
Name:FUSON, EDNA P (MD)
Entity Type:Individual
Prefix:MRS
First Name:EDNA
Middle Name:P
Last Name:FUSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2534 FOSTERS ROAD
Mailing Address - Street 2:
Mailing Address - City:DELTA
Mailing Address - State:AL
Mailing Address - Zip Code:36258-2534
Mailing Address - Country:US
Mailing Address - Phone:256-488-9339
Mailing Address - Fax:
Practice Address - Street 1:2534 FOSTERS ROAD
Practice Address - Street 2:
Practice Address - City:DELTA
Practice Address - State:AL
Practice Address - Zip Code:36258-2534
Practice Address - Country:US
Practice Address - Phone:256-488-9339
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-24
Last Update Date:2015-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4087208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics