Provider Demographics
NPI:1043284458
Name:EDWARDS, JONATHAN (MD)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:147 ASHELAND AVE
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28801-4013
Mailing Address - Country:US
Mailing Address - Phone:828-258-1188
Mailing Address - Fax:
Practice Address - Street 1:2685 METROPOLITAN PKWY SW STE G
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30315-7926
Practice Address - Country:US
Practice Address - Phone:404-596-4344
Practice Address - Fax:844-935-6886
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC94-00481207R00000X
GA84130207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCN00481Medicaid
NC8930097Medicaid
NC2202190CMedicare PIN
NC8930097Medicaid
NC2202190BMedicare ID - Type Unspecified