Provider Demographics
NPI:1689873176
Name:B.O. EDWARDS, M.D., LLC
Entity Type:Organization
Organization Name:B.O. EDWARDS, M.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BUFORD
Authorized Official - Middle Name:OTTO
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:706-769-7911
Mailing Address - Street 1:1030 WOODLANDS RD
Mailing Address - Street 2:PO BOX 110
Mailing Address - City:WATKINSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30677-1990
Mailing Address - Country:US
Mailing Address - Phone:706-769-7911
Mailing Address - Fax:706-769-0826
Practice Address - Street 1:1030 WOODLANDS RD
Practice Address - Street 2:BOX 110
Practice Address - City:WATKINSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30677-1990
Practice Address - Country:US
Practice Address - Phone:706-769-7911
Practice Address - Fax:706-769-0826
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-13
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA028160208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty