Healthcare Provider Details

I. General information

NPI: 1407944499
Provider Name (Legal Business Name): EDWARD CHARLES GNAM III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

971 LAKELAND DR STE 252
JACKSON MS
39216-4643
US

IV. Provider business mailing address

5959 S SHERWOOD FOREST BLVD
BATON ROUGE LA
70816-6038
US

V. Phone/Fax

Practice location:
  • Phone: 601-200-6262
  • Fax:
Mailing address:
  • Phone: 601-200-6262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number15459
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: