Provider Demographics
NPI:1609898808
Name:EDWARDS, BYARD III (MD)
Entity Type:Individual
Prefix:
First Name:BYARD
Middle Name:
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 1:3024 BUSINESS PARK CIR
Mailing Address - Street 2:
Mailing Address - City:GOODLETTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37072-3132
Mailing Address - Country:US
Mailing Address - Phone:615-851-6033
Mailing Address - Fax:615-851-2018
Practice Address - Street 1:3024 BUSINESS PARK CIR
Practice Address - Street 2:
Practice Address - City:GOODLETTSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37072-3132
Practice Address - Country:US
Practice Address - Phone:615-851-6033
Practice Address - Fax:615-851-2018
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA804022085R0202X
TN437562085R0202X, 2085B0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3001761OtherMEDICARE PTAN FOR NOL
TN4291547OtherBCBS - MTI
TN1509263OtherMEDICAID - MTI
TN3001762OtherMEDICARE PTAN FOR ADI
TN4203618OtherBCBS TN
KY7100049270Medicaid
TN1509263Medicaid
TN3001762OtherMEDICARE PTAN FOR ADI
TN3001761OtherMEDICARE PTAN FOR NOL
CAZZZP4316ZMedicare ID - Type Unspecified