Provider Demographics
NPI:1407944499
Name:GNAM, EDWARD CHARLES III (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:CHARLES
Last Name:GNAM
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1050 RIVER OAKS DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-9564
Mailing Address - Country:US
Mailing Address - Phone:601-420-0134
Mailing Address - Fax:601-420-0547
Practice Address - Street 1:1050 RIVER OAKS DR
Practice Address - Street 2:SUITE 200
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-9564
Practice Address - Country:US
Practice Address - Phone:601-420-0134
Practice Address - Fax:601-420-0547
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MS15459207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00122303Medicaid
MS00122303Medicaid