Provider Demographics
NPI:1851329445
Name:EDMONDSON, W DANIEL (MD)
Entity Type:Individual
Prefix:MR
First Name:W
Middle Name:DANIEL
Last Name:EDMONDSON
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 1:1607 WESTGATE CIRCLE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027
Mailing Address - Country:US
Mailing Address - Phone:615-376-8195
Mailing Address - Fax:615-376-2601
Practice Address - Street 1:1607 WESTGATE CIRCLE
Practice Address - Street 2:SUITE 200
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027
Practice Address - Country:US
Practice Address - Phone:615-376-8195
Practice Address - Fax:615-376-2601
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN27443207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3802940Medicare ID - Type Unspecified
G28852Medicare UPIN