MEDICARE: DR. JONATHAN EDWARDS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	94-00481	NC
2	207R00000X	Internal Medicine Physician	84130	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043284458
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JONATHAN EDWARDS M.D.

Provider Business Mailing Address
First Line	:	147 ASHELAND AVE
Second Line	:
City	:	ASHEVILLE
State	:	NC
Zip	:	28801-4013
Country	:	US
Telephone Number	:	828-258-1188
Fax Number	:

Provider Business Practice Location Address
First Line	:	2685 METROPOLITAN PKWY SW STE G
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30315-7926
Country	:	US
Telephone Number	:	404-596-4344
Fax Number	:	844-935-6886

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/14/2006
Last Update Date	:	07/30/2020

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