MEDICARE: DR. MIRANDA Y. 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	207Q00000X	Family Medicine Physician	049971	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

General Provider Information

NPI Number	:	1295758597
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MIRANDA Y. EDWARDS M.D.

Provider Business Mailing Address
First Line	:	PO BOX 4173
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31914-0173
Country	:	US
Telephone Number	:	706-243-2900
Fax Number	:	706-243-2903

Provider Business Practice Location Address
First Line	:	500 18TH ST
Second Line	:	SUITE A-10
City	:	COLUMBUS
State	:	GA
Zip	:	31901-1536
Country	:	US
Telephone Number	:	706-243-2900
Fax Number	:	706-243-2903

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

Provider Enumeration Date	:	07/26/2006
Last Update Date	:	02/15/2011

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