Provider Demographics
NPI:1912051269
Name:EDWARDS, ERNEST LEROY JR (BS)
Entity Type:Individual
Prefix:
First Name:ERNEST
Middle Name:LEROY
Last Name:EDWARDS
Suffix:JR
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:157 BECKY GIBSON RD
Mailing Address - Street 2:
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29651-5244
Mailing Address - Country:US
Mailing Address - Phone:864-848-3199
Mailing Address - Fax:
Practice Address - Street 1:157 BECKY GIBSON RD
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29651-5244
Practice Address - Country:US
Practice Address - Phone:864-848-3199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator