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NPI Code Detail

MEDICARE: SUSAN G EDWARDS PA C

MEDICARE: SUSAN G EDWARDS PA C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant103171NC

General Provider Information

NPI Number : 1356453120
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUSAN G EDWARDS PA C
Provider Business Mailing Address
First Line : 3333 NC HIGHWAY 242 N
Second Line :
City : BENSON
State : NC
Zip : 27504-7844
Country : US
Telephone Number : 919-894-2011
Fax Number : 919-894-7645
Provider Business Practice Location Address
First Line : 3333 NC HIGHWAY 242 N
Second Line :
City : BENSON
State : NC
Zip : 27504-7844
Country : US
Telephone Number : 919-894-2011
Fax Number : 919-894-7645
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/31/2006
Last Update Date : 10/03/2012

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1740216506 — DR. EUGENE H MAYNARD JR. M.D.
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1235220104 — MRS. APRIL G POPE PA-C
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Directions to “ SUSAN G EDWARDS PA C” Practice Location

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