Provider Demographics
NPI:1295964088
Name:EDWARDS, MICHAEL J SR (MINISTER)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:J
Last Name:EDWARDS
Suffix:SR
Gender:M
Credentials:MINISTER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1017 HANEY RD STE C
Mailing Address - Street 2:
Mailing Address - City:SUMMIT
Mailing Address - State:MS
Mailing Address - Zip Code:39666-9079
Mailing Address - Country:US
Mailing Address - Phone:601-810-5788
Mailing Address - Fax:
Practice Address - Street 1:2102 TRADEWIND DR
Practice Address - Street 2:SUITE 172
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-3309
Practice Address - Country:US
Practice Address - Phone:601-810-5788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-14
Last Update Date:2012-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No172V00000XOther Service ProvidersCommunity Health Worker
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No171100000XOther Service ProvidersAcupuncturist
No172A00000XOther Service ProvidersDriver
No372600000XNursing Service Related ProvidersAdult Companion
No372500000XNursing Service Related ProvidersChore Provider
No374K00000XNursing Service Related ProvidersReligious Nonmedical Practitioner
No171R00000XOther Service ProvidersInterpreter