Provider Demographics
NPI:1336550425
Name:EDWARDS, MEGAN BLAIR (DO)
Entity Type:Individual
Prefix:DR
First Name:MEGAN
Middle Name:BLAIR
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2908 S LAMAR BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-5375
Mailing Address - Country:US
Mailing Address - Phone:662-281-0112
Mailing Address - Fax:662-281-0943
Practice Address - Street 1:2908 S LAMAR BLVD STE 100
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-5375
Practice Address - Country:US
Practice Address - Phone:662-281-0112
Practice Address - Fax:662-281-0943
Is Sole Proprietor?:No
Enumeration Date:2014-05-12
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS257182084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00138027Medicaid