Healthcare Provider Details

I. General information

NPI: 1548229636
Provider Name (Legal Business Name): GEORGE DANIEL EDWARDS III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 4TH STREET
ALEXANDRIA LA
71301
US

IV. Provider business mailing address

5150 HUNTER GROVE LANE
ALEXANDRIA LA
71303
US

V. Phone/Fax

Practice location:
  • Phone: 318-473-3111
  • Fax:
Mailing address:
  • Phone: 318-487-0037
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number014574
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: