Provider Demographics
NPI:1336412444
Name:EDENFIELD, DARRELL CHAD (CSTFA)
Entity Type:Individual
Prefix:
First Name:DARRELL
Middle Name:CHAD
Last Name:EDENFIELD
Suffix:
Gender:M
Credentials:CSTFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11909 MCAULEY DR STE 100A2
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31419-1793
Mailing Address - Country:US
Mailing Address - Phone:912-925-3767
Mailing Address - Fax:912-925-3659
Practice Address - Street 1:11909 MCAULEY DR STE 100A2
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31419-1793
Practice Address - Country:US
Practice Address - Phone:912-925-3767
Practice Address - Fax:912-925-3659
Is Sole Proprietor?:No
Enumeration Date:2012-02-21
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363AS0400X
GANB0030960363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical