Provider Demographics
NPI:1447477344
Name:EDWARDS, ANN MARIE HARRILL (MD)
Entity type:Individual
Prefix:
First Name:ANN MARIE
Middle Name:HARRILL
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 E MCBEE AVE FL 4
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-2842
Mailing Address - Country:US
Mailing Address - Phone:864-522-8603
Mailing Address - Fax:
Practice Address - Street 1:249 NORTH GROVE MEDICAL PARK DR
Practice Address - Street 2:STE 100
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29603-4222
Practice Address - Country:US
Practice Address - Phone:864-582-8135
Practice Address - Fax:864-573-9757
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC35121208000000X, 208000000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC351210Medicaid
SCAPPROVEDMedicare PIN