Provider Demographics
NPI:1184243321
Name:EDMONDSON, EMERY (DO)
Entity type:Individual
Prefix:
First Name:EMERY
Middle Name:
Last Name:EDMONDSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 ROBBINS ST
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06708-2600
Mailing Address - Country:US
Mailing Address - Phone:203-573-7257
Mailing Address - Fax:203-573-6073
Practice Address - Street 1:220 BMH CANCER CTR
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37804-5922
Practice Address - Country:US
Practice Address - Phone:865-238-6600
Practice Address - Fax:865-238-6605
Is Sole Proprietor?:No
Enumeration Date:2020-04-08
Last Update Date:2025-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TN6422208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program