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General NPI Number Information
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NPI Number | 1356458947
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Entity Type | Organization
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Legal Business Name | CARL EDWARDS, MD, PLC
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Dates
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Enumeration Date | 08/23/2006
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Last Update Date | 04/28/2008
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Provider Practice Location Address
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Address Line | 505 E MATTHEWS AVE STE 203
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City | JONESBORO
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State | AR
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Zip | 72401-3101
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Country | US
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Telephone | 870-268-9727
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Fax | 870-268-9744
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Provider Business Mailing Address
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Address Line | 505 E MATTHEWS AVE STE 203
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City | JONESBORO
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State | AR
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Zip | 72401-3101
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Country | US
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Telephone | 870-268-9727
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Fax | 870-268-9744
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. MARSHA SUE SPEAKMAN
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Credential |
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Telephone | 870-268-9727
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | R4353
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License Number State | AR
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