MEDICARE: LAVON EDWARDS MD

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
1	174H00000X	Health Educator

General Provider Information

NPI Number	:	1760235733
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAVON EDWARDS MD

Provider Business Mailing Address
First Line	:	6559 W FAYETTEVILLE RD
Second Line	:
City	:	RIVERDALE
State	:	GA
Zip	:	30296-2522
Country	:	US
Telephone Number	:	254-462-9406
Fax Number	:

Provider Business Practice Location Address
First Line	:	6559 W FAYETTEVILLE RD
Second Line	:
City	:	RIVERDALE
State	:	GA
Zip	:	30296-2522
Country	:	US
Telephone Number	:	254-462-9406
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/09/2024
Last Update Date	:	04/09/2024

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Directions to “ LAVON EDWARDS MD” Practice Location

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