Healthcare Provider Details

I. General information

NPI: 1548252141
Provider Name (Legal Business Name): EDWARD CHANDLER MCDAVID MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2005
Last Update Date: 03/18/2021
Certification Date: 02/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 MEDICAL ARTS DR
SANDERSVILLE GA
31082-1987
US

IV. Provider business mailing address

205 MEDICAL ARTS DR
SANDERSVILLE GA
31082-1987
US

V. Phone/Fax

Practice location:
  • Phone: 478-552-2020
  • Fax: 478-552-3714
Mailing address:
  • Phone: 478-552-2020
  • Fax: 478-552-3714

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberO26794
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: