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NPI Code Detail

MEDICARE: EDWIN W NUNNERY JR. MD

MEDICARE: EDWIN W NUNNERY JR. MD
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
1207ZP0102XAnatomic Pathology & Clinical Pathology Physician023649GA

General Provider Information

NPI Number : 1568467447
Entity Type Code : Individual
Provider Name (Legal Business Name) : EDWIN W NUNNERY JR. MD
Provider Business Mailing Address
First Line : 2800 KEAGY ROAD
Second Line :
City : SALEM
State : VA
Zip : 24153-7458
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1700 MEDICAL WAY
Second Line :
City : SNELLVILLE
State : GA
Zip : 30078-2195
Country : US
Telephone Number : 770-736-2408
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/16/2005
Last Update Date : 08/25/2009

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