Healthcare Provider Details

I. General information

NPI: 1407220718
Provider Name (Legal Business Name): EDNA P. FUSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/24/2015
Last Update Date: 11/16/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2534 FOSTERS ROAD
DELTA AL
36258-2534
US

IV. Provider business mailing address

2534 FOSTERS ROAD
DELTA AL
36258-2534
US

V. Phone/Fax

Practice location:
  • Phone: 256-488-9339
  • Fax:
Mailing address:
  • Phone: 256-488-9339
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4087
License Number StateAL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: