Provider Demographics
NPI:1023449980
Name:EDWARDS, CREIGHTON BRAD
Entity type:Individual
Prefix:
First Name:CREIGHTON
Middle Name:BRAD
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:BRAD
Other - Middle Name:
Other - Last Name:EDWARDS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6100 MADDRY OAKS CT
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27616-3156
Mailing Address - Country:US
Mailing Address - Phone:919-256-1805
Mailing Address - Fax:919-256-1806
Practice Address - Street 1:6100 MADDRY OAKS CT
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27616-3156
Practice Address - Country:US
Practice Address - Phone:919-256-1805
Practice Address - Fax:919-256-1806
Is Sole Proprietor?:No
Enumeration Date:2013-12-03
Last Update Date:2013-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic