Provider Demographics
NPI:1336350206
Name:EDWARDS, DERRICK QUINTON (MD)
Entity Type:Individual
Prefix:DR
First Name:DERRICK
Middle Name:QUINTON
Last Name:EDWARDS
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 1:4 WILLOW PT STE 50
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-1150
Mailing Address - Country:US
Mailing Address - Phone:601-296-3070
Mailing Address - Fax:601-296-3087
Practice Address - Street 1:4 WILLOW PT STE 50
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-1150
Practice Address - Country:US
Practice Address - Phone:601-296-3070
Practice Address - Fax:601-296-3087
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MST-1934207R00000X
MS20228207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine