Provider Demographics
NPI:1518711910
Name:EDWARDS, GREGORY MICHAEL (PMHNP-BC)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:MICHAEL
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:248 JAMES F WATSON RD
Mailing Address - Street 2:
Mailing Address - City:WEST JEFFERSON
Mailing Address - State:NC
Mailing Address - Zip Code:28694-9285
Mailing Address - Country:US
Mailing Address - Phone:480-907-8318
Mailing Address - Fax:
Practice Address - Street 1:248 JAMES F WATSON RD
Practice Address - Street 2:
Practice Address - City:WEST JEFFERSON
Practice Address - State:NC
Practice Address - Zip Code:28694-9285
Practice Address - Country:US
Practice Address - Phone:480-907-8318
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-15
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5019906363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health