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General NPI Number Information
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NPI Number | 1730323254
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Entity Type | Individual
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Provider Name | JACOB EDWARDS MD
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Gender | Male
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Dates
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Enumeration Date | 04/28/2009
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Last Update Date | 05/21/2025
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Provider Practice Location Address
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Address Line | 350 WINN WAY
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City | DECATUR
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State | GA
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Zip | 30030-2106
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Country | US
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Telephone | 404-508-1177
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Fax | 404-508-9640
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Provider Business Mailing Address
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Address Line | 1528 MONARCH DR
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City | MARIETTA
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State | GA
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Zip | 30062-2748
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Country | US
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Telephone | 404-213-1581
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | MD.31940
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License Number State | AL
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