Provider Demographics
NPI:1548229636
Name:EDWARDS, GEORGE DANIEL III (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:DANIEL
Last Name:EDWARDS
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5150 HUNTER GROVE LANE
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71303
Mailing Address - Country:US
Mailing Address - Phone:318-487-0037
Mailing Address - Fax:
Practice Address - Street 1:211 4TH STREET
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301
Practice Address - Country:US
Practice Address - Phone:318-473-3111
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA014574207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1328405Medicaid
D79787Medicare UPIN
LA51841Medicare ID - Type Unspecified