Provider Demographics
NPI:1457503377
Name:EDWARDS, LONNIE CALVIN II (CM I)
Entity Type:Individual
Prefix:MR
First Name:LONNIE
Middle Name:CALVIN
Last Name:EDWARDS
Suffix:II
Gender:M
Credentials:CM I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2328 W NEWTON ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74127-3017
Mailing Address - Country:US
Mailing Address - Phone:501-612-6046
Mailing Address - Fax:
Practice Address - Street 1:5553 S PEORIA AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74105-6800
Practice Address - Country:US
Practice Address - Phone:918-779-4556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-22
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator