MEDICARE: BENJAMIN THOMAS 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	1041C0700X	Clinical Social Worker		NC

General Provider Information

NPI Number	:	1639024797
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BENJAMIN THOMAS EDWARDS

Provider Business Mailing Address
First Line	:	108 BRAXBERRY WAY
Second Line	:
City	:	HOLLY SPRINGS
State	:	NC
Zip	:	27540-8452
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	108 BRAXBERRY WAY
Second Line	:
City	:	HOLLY SPRINGS
State	:	NC
Zip	:	27540-8452
Country	:	US
Telephone Number	:	919-665-7493
Fax Number	:

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

Provider Enumeration Date	:	03/03/2026
Last Update Date	:	03/03/2026

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