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Individual

DR. ANTONIO DESSELL EDWARDS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
25073 HIGHWAY 1 S, PLAQUEMINE, LA 70764-4431
(225) 687-1772
(225) 687-1013
Mailing address
25073 HIGHWAY 1 S, PLAQUEMINE, LA 70764-4431
(225) 687-1772
(225) 687-1013

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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