Provider Demographics
NPI:1871695197
Name:EDWARDS, JONATHAN LEE (MD)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:LEE
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 1:155 5TH STREET NE
Mailing Address - Street 2:
Mailing Address - City:BARBERTON
Mailing Address - State:OH
Mailing Address - Zip Code:44203
Mailing Address - Country:US
Mailing Address - Phone:330-615-3205
Mailing Address - Fax:330-615-3221
Practice Address - Street 1:155 5TH STREET NE
Practice Address - Street 2:
Practice Address - City:BARBERTON
Practice Address - State:OH
Practice Address - Zip Code:44203
Practice Address - Country:US
Practice Address - Phone:330-615-3205
Practice Address - Fax:330-615-3221
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35079130207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2349980Medicaid
OH2349980Medicaid
OH4311111Medicare PIN