Provider Demographics
NPI:1265703557
Name:COURTNEY, EDWARD MONROE JR (MPT)
Entity type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:MONROE
Last Name:COURTNEY
Suffix:JR
Gender:M
Credentials:MPT
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:300 EAST HOSPITAL ROAD
Mailing Address - Street 2:D.D. EISENHOWER ARMY MEDICAL CENTER ROOM 12C-25
Mailing Address - City:AUGUSTA FORT GORDON
Mailing Address - State:GA
Mailing Address - Zip Code:30905-5650
Mailing Address - Country:US
Mailing Address - Phone:706-787-8441
Mailing Address - Fax:706-787-1327
Practice Address - Street 1:300 EAST HOSPITAL ROAD
Practice Address - Street 2:D.D. EISENHOWER ARMY MEDICAL CENTER ROOM 12C-25
Practice Address - City:AUGUSTA FORT GORDON
Practice Address - State:GA
Practice Address - Zip Code:30905-5650
Practice Address - Country:US
Practice Address - Phone:706-787-8441
Practice Address - Fax:706-787-1327
Is Sole Proprietor?:No
Enumeration Date:2012-01-19
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT007866246Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other