Provider Demographics
NPI:1821295544
Name:AGEE, EDITH C (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:EDITH
Middle Name:C
Last Name:AGEE
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36106-1112
Mailing Address - Country:US
Mailing Address - Phone:334-265-9225
Mailing Address - Fax:334-240-6653
Practice Address - Street 1:2101 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106-1112
Practice Address - Country:US
Practice Address - Phone:334-265-9225
Practice Address - Fax:334-240-6653
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPA-62363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALR44816Medicare UPIN