MEDICARE: DAVID MITCHELL EDWARDS

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	1710I1002X	Independent Duty Corpsman	1710I1002X

General Provider Information

NPI Number	:	1083670194
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID MITCHELL EDWARDS

Provider Business Mailing Address
First Line	:	304 MATHEWS RDG
Second Line	:
City	:	SAINT MARYS
State	:	GA
Zip	:	31558-2852
Country	:	US
Telephone Number	:	912-874-8664
Fax Number	:

Provider Business Practice Location Address
First Line	:	USS MARYLAND SSBN 738 BLUE
Second Line	:
City	:	FPO
State	:	AA
Zip	:	34092-2129
Country	:	US
Telephone Number	:	912-874-8664
Fax Number	:

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

Provider Enumeration Date	:	04/26/2006
Last Update Date	:	05/13/2008

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Directions to “ DAVID MITCHELL EDWARDS ” Practice Location

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