Healthcare Provider Details

I. General information

NPI: 1215224563
Provider Name (Legal Business Name): CEDRIC EDWARDS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2011
Last Update Date: 01/19/2021
Certification Date: 01/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

590 HIGHWAY 6 E
BATESVILLE MS
38606-3002
US

IV. Provider business mailing address

2340 SUNSET DR STE C
GRENADA MS
38901-2827
US

V. Phone/Fax

Practice location:
  • Phone: 662-563-8703
  • Fax:
Mailing address:
  • Phone: 662-508-0098
  • Fax: 662-735-6010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number21739
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number21739
License Number StateMS
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number21739
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: