Individual
MR. JUSTIN G. EDWARDS
Active
Individual
MR. JUSTIN G. EDWARDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA2874
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA2874
MEDICAL LICENSE
TN
Enumeration date
08/22/2014
Last updated
12/27/2019
Update your record
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