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General NPI Number Information
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NPI Number | 1154700227
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Entity Type | Individual
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Provider Name | JACOB DANIEL EDWARDS M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/22/2015
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Last Update Date | 09/14/2022
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Provider Practice Location Address
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Address Line | 1924 ALCOA HWY
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City | KNOXVILLE
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State | TN
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Zip | 37920-1511
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Country | US
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Telephone | 865-670-6754
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Fax |
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Provider Business Mailing Address
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Address Line | 2100 STANTONSBURG RD
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City | GREENVILLE
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State | NC
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Zip | 27834-2818
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Country | US
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Telephone | 252-744-2393
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Fax | 252-744-3156
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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 | 2086S0102X
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Taxonomy Name | Surgical Critical Care Physician
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License Number | 66216
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 66216
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License Number State | TN
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