Provider Demographics
NPI:1700908340
Name:EDWARDS, MARCUS B (DC)
Entity Type:Individual
Prefix:DR
First Name:MARCUS
Middle Name:B
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2205 ROSEMONT DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-7368
Mailing Address - Country:US
Mailing Address - Phone:706-565-9447
Mailing Address - Fax:706-565-5013
Practice Address - Street 1:2205 ROSEMONT DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-7368
Practice Address - Country:US
Practice Address - Phone:706-565-9447
Practice Address - Fax:706-565-5013
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0007111111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U91131Medicare UPIN
GA35ZCGXGMedicare ID - Type Unspecified