Provider Demographics
NPI:1639582331
Name:EDMONDSON, GABRIEL LEE (DO)
Entity Type:Individual
Prefix:
First Name:GABRIEL
Middle Name:LEE
Last Name:EDMONDSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:149 TURKEY RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:VA
Mailing Address - Zip Code:24171-5346
Mailing Address - Country:US
Mailing Address - Phone:229-387-1883
Mailing Address - Fax:
Practice Address - Street 1:180 FERRUM MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:FERRUM
Practice Address - State:VA
Practice Address - Zip Code:24088-2939
Practice Address - Country:US
Practice Address - Phone:540-365-4469
Practice Address - Fax:540-365-4272
Is Sole Proprietor?:No
Enumeration Date:2014-06-10
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0116027199207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine