Healthcare Provider Details

I. General information

NPI: 1942261219
Provider Name (Legal Business Name): JOHN SAWYER EDWARDS III PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: TAD EDWARDS PA-C

II. Dates (important events)

Enumeration Date: 03/28/2006
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2817 ROCK MERRITT AVE
FORT BRAGG NC
28310-0001
US

IV. Provider business mailing address

2817 ROCK MERRITT AVENUE
FORT BRAGG NC
28310-0001
US

V. Phone/Fax

Practice location:
  • Phone: 910-907-8922
  • Fax: 910-907-6069
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA61066250
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: