Provider Demographics
NPI:1750382545
Name:EDWARDS, ROBERT (DO)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 ENTERPRISE CT
Mailing Address - Street 2:STE C
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-9096
Mailing Address - Country:US
Mailing Address - Phone:706-321-0476
Mailing Address - Fax:
Practice Address - Street 1:106 ENTERPRISE CT
Practice Address - Street 2:A
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-3089
Practice Address - Country:US
Practice Address - Phone:706-321-2555
Practice Address - Fax:706-323-0245
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA048621208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA02BBCLDMedicare ID - Type UnspecifiedGENERAL SURGERY