Provider Demographics
NPI:1982765475
Name:LAMMONS, EDWARD IRVING (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:IRVING
Last Name:LAMMONS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 399
Mailing Address - Street 2:
Mailing Address - City:PHENIX CITY
Mailing Address - State:AL
Mailing Address - Zip Code:36868-0399
Mailing Address - Country:US
Mailing Address - Phone:334-291-0071
Mailing Address - Fax:334-291-9873
Practice Address - Street 1:701 13TH ST
Practice Address - Street 2:
Practice Address - City:PHENIX CITY
Practice Address - State:AL
Practice Address - Zip Code:36867-5038
Practice Address - Country:US
Practice Address - Phone:334-291-0071
Practice Address - Fax:334-291-9873
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00005532207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL3510Medicaid
C72492Medicare ID - Type Unspecified
AL3510Medicaid