Healthcare Provider Details

I. General information

NPI: 1225851827
Provider Name (Legal Business Name): MARY ZIPPORAH EDWARDS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2024
Last Update Date: 07/16/2025
Certification Date: 07/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3007 WESLEY CHAPEL STOUTS RD
MONROE NC
28110-4007
US

IV. Provider business mailing address

3007 WESLEY CHAPEL STOUTS RD
MONROE NC
28110-4007
US

V. Phone/Fax

Practice location:
  • Phone: 704-412-3612
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number0010-14759
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: