Provider Demographics
NPI:1780330753
Name:EDWARDS, DERRICK
Entity type:Individual
Prefix:MR
First Name:DERRICK
Middle Name:
Last Name:EDWARDS
Suffix:
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 1:900 DOWNTOWNER BLVD APT 413
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36609-9415
Mailing Address - Country:US
Mailing Address - Phone:251-259-2718
Mailing Address - Fax:
Practice Address - Street 1:900 DOWNTOWNER BLVD APT 413
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36609-9415
Practice Address - Country:US
Practice Address - Phone:251-259-2718
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-28
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALUNKNOWNMedicaid