Individual
MR. CLYDE RICHARD EDWARDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1655 WAKE DR, SUITE 101, WAKE FOREST, NC 27587-4745
(919) 556-4779
(919) 556-5277
Mailing address
1655 WAKE DR, SUITE 101, WAKE FOREST, NC 27587-4745
(919) 556-4779
(919) 556-5277
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
102843
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
102843
NORTH CAROLINA LICENSE
NC
Enumeration date
10/28/2005
Last updated
09/25/2013
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