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Individual
DR. ANTONIO DESSELL EDWARDS
Active
Individual
DR. ANTONIO DESSELL EDWARDS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
12515R
LA
207Q00000X
Family Medicine Physician
84438
GA
207QA0401X
Addiction Medicine (Family Medicine) Physician
12515R
LA
207QA0401X
Addiction Medicine (Family Medicine) Physician
84438
GA
405300000X
Prevention Professional
12515R
LA
405300000X
Prevention Professional
84438
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1534358
—
LA
Enumeration date
01/22/2007
Last updated
05/12/2020
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