Provider Demographics
NPI:1790751816
Name:MOLNAR, EDMUND MCDONALD JR (MD)
Entity Type:Individual
Prefix:
First Name:EDMUND
Middle Name:MCDONALD
Last Name:MOLNAR
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1038
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31902-1038
Mailing Address - Country:US
Mailing Address - Phone:706-660-6148
Mailing Address - Fax:706-660-2843
Practice Address - Street 1:920 18TH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31901-1524
Practice Address - Country:US
Practice Address - Phone:706-649-6600
Practice Address - Fax:706-649-6614
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2014-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA042363208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL600-12067OtherBCBS
AL600-96984OtherBCBS
GA0007401627EOtherMEDICAID-MMC
GA000740627DOtherMEDICAID-OFFICE
AL154045OtherMEDICAID-OFFICE
GA000740627AMedicaid
GA52596568-001OtherBCBS
AL00970485Medicaid
GA20035982OtherRAILROAD MEDICARE
GA52596568-002OtherBCBS
GA52596568-002OtherBCBS
GA02BDFCXMedicare ID - Type Unspecified