Provider Demographics
NPI:1497851133
Name:FARNELL, EDWIN ALONZO IV (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWIN
Middle Name:ALONZO
Last Name:FARNELL
Suffix:IV
Gender:M
Credentials:MD
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Mailing Address - Street 1:300 W HOSPITAL RD
Mailing Address - Street 2:
Mailing Address - City:FORT EISENHOWER
Mailing Address - State:GA
Mailing Address - Zip Code:30905-5741
Mailing Address - Country:US
Mailing Address - Phone:706-787-2776
Mailing Address - Fax:706-787-8176
Practice Address - Street 1:300 W HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:FORT EISENHOWER
Practice Address - State:GA
Practice Address - Zip Code:30905-5741
Practice Address - Country:US
Practice Address - Phone:706-787-2776
Practice Address - Fax:706-787-8176
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2023-10-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KS31194207Q00000X
GA62689207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAVAD 000Medicare UPIN