Provider Demographics
NPI:1720681497
Name:EDMONDS, TOMMY EDWARD JR
Entity Type:Individual
Prefix:
First Name:TOMMY
Middle Name:EDWARD
Last Name:EDMONDS
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:830 VIRGINIA AVE W APT 2
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25704-1760
Mailing Address - Country:US
Mailing Address - Phone:304-691-9422
Mailing Address - Fax:
Practice Address - Street 1:830 VIRGINIA AVE W APT 2
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25704-1760
Practice Address - Country:US
Practice Address - Phone:304-691-9422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-17
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant