Healthcare Provider Details

I. General information

NPI: 1730253220
Provider Name (Legal Business Name): DAVID L EDWARDS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 HAWTHORNE AVE STE O
ATHENS GA
30606-2168
US

IV. Provider business mailing address

PO BOX 1728
WATKINSVILLE GA
30677-0034
US

V. Phone/Fax

Practice location:
  • Phone: 678-689-1100
  • Fax: 678-722-8206
Mailing address:
  • Phone: 678-689-1100
  • Fax: 706-612-1620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number026511
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: