MEDICARE: DR. DERRICK QUINTON 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	207RC0000X	Cardiovascular Disease Physician	20228	MS
2	207R00000X	Internal Medicine Physician	T-1934	MS
3	207RC0000X	Cardiovascular Disease Physician	104563	GA

General Provider Information

NPI Number	:	1336350206
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DERRICK QUINTON EDWARDS M.D.

Provider Business Mailing Address
First Line	:	619 S 8TH ST STE 201
Second Line	:
City	:	GRIFFIN
State	:	GA
Zip	:	30224-4260
Country	:	US
Telephone Number	:	470-267-3950
Fax Number	:	770-999-2843

Provider Business Practice Location Address
First Line	:	619 S 8TH ST STE 201
Second Line	:
City	:	GRIFFIN
State	:	GA
Zip	:	30224-4260
Country	:	US
Telephone Number	:	470-267-3950
Fax Number	:	770-999-2843

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

Provider Enumeration Date	:	05/24/2007
Last Update Date	:	04/16/2026

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