Provider Demographics
NPI:1598768145
Name:EDWARDS, TANIA C (DO)
Entity Type:Individual
Prefix:
First Name:TANIA
Middle Name:C
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1414 ELBA HWY
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:AL
Mailing Address - Zip Code:36079-6020
Mailing Address - Country:US
Mailing Address - Phone:334-670-6726
Mailing Address - Fax:334-670-6731
Practice Address - Street 1:23 VETERANS BLVD
Practice Address - Street 2:
Practice Address - City:EUFAULA
Practice Address - State:AL
Practice Address - Zip Code:36027-4444
Practice Address - Country:US
Practice Address - Phone:334-687-8051
Practice Address - Fax:334-687-8027
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-27
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA053465207Q00000X
ALDO.917207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA206060895AMedicaid
GA206060895AMedicaid
GA08BBRBCMedicare ID - Type Unspecified
GAHOSP3Medicare PIN