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General NPI Number Information
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NPI Number | 1124153838
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Entity Type | Individual
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Provider Name | CHARLES RANDALL EDWARDS PH.D.
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Gender | Male
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Dates
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Enumeration Date | 02/22/2007
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Last Update Date | 07/26/2007
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Provider Practice Location Address
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Address Line | 1303 GREENSBORO STREET EXT
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City | LEXINGTON
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State | NC
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Zip | 27295-1924
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Country | US
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Telephone | 336-249-0237
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Fax | 336-243-7685
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Provider Business Mailing Address
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Address Line | 202 FAIRVIEW RD
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City | THOMASVILLE
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State | NC
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Zip | 27360-3822
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Country | US
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Telephone | 336-472-7509
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 0879
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License Number State | NC
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