Provider Demographics
NPI:1295596518
Name:EDWARDS, ADAM J
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:J
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:158 E MAPLEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:49444-3079
Mailing Address - Country:US
Mailing Address - Phone:231-268-4321
Mailing Address - Fax:
Practice Address - Street 1:158 E MAPLEWOOD AVE
Practice Address - Street 2:
Practice Address - City:MUSKEGON HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:49444-3079
Practice Address - Country:US
Practice Address - Phone:231-268-4321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-23
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No171WH0202XOther Service ProvidersContractorHome Modifications