Physician Compare National (NPI:1376739151)

HEALTHCARE PROVIDER: DAVISSON JEAN LEANDRE F E EDMOND M.D

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1376739151
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	2466515630
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20110104000734
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	EDMOND
	Individual professional last name
Provider First Name	DAVISSON
	Individual professional first name
Provider Middle Name	JEAN LEANDRE F E
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	UNIVERSITE DE MONTREAL FACULTE DE MED DENTAIRE
	Individual professional's medical school
Graduation Year	2004
	Individual professional's medical school graduation year
Primary Specialty	FAMILY MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	612 CALHOUN ST
	Group Practice or individual's line 1 address
City	PIEDMONT
	Group Practice or individual's city
State	AL
	Group Practice or individual's state
Zip Code	362721939
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	010078
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	NORTHEAST ALABAMA REGIONAL MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	010038
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	STRINGFELLOW MEMORIAL HOSPITAL
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	Y