Provider Demographics
NPI:1831100148
Name:EDWARDS, NATHANIEL C (MD)
Entity Type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:C
Last Name:EDWARDS
Suffix:
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:PO BOX 19305
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28219-9305
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1656 RIVERCHASE BLVD
Practice Address - Street 2:SUITE 2500
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-2084
Practice Address - Country:US
Practice Address - Phone:803-327-3456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9700540207R00000X, 207RI0011X, 207RC0000X, 207RI0011X, 207RC0000X
SC19173207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP00200649OtherRAILROAD MEDICARE
NC1831100148Medicaid
NC790546VMedicaid
NC0546VOtherBCBS
SCP00200665OtherRAILROAD MEDICARE
SC191731Medicaid
NC790546VMedicaid
SC191731Medicaid
NCNC3511AMedicare PIN
NC1831100148Medicaid
NCNC3511BMedicare PIN