Provider Demographics
NPI:1447341979
Name:MINOR, EDWARD ALAN (MD)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:ALAN
Last Name:MINOR
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2100 COMER AVE
Mailing Address - Street 2:BOX 5328
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-8725
Mailing Address - Country:US
Mailing Address - Phone:706-596-5557
Mailing Address - Fax:706-596-5569
Practice Address - Street 1:2100 COMER AVE
Practice Address - Street 2:BOX 5328
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-8725
Practice Address - Country:US
Practice Address - Phone:706-596-5557
Practice Address - Fax:706-596-5569
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA0450952084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
H51450Medicare UPIN
26BDHQWMedicare ID - Type Unspecified