Individual
SHELISE EDWARDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
235 PEACHTREE ST NE, NORTH TOWER, SUITE 2100, ATLANTA, GA 30303-1401
(770) 994-9326
(770) 994-4747
Mailing address
235 PEACHTREE ST NE, NORTH TOWER, SUITE 2100, ATLANTA, GA 30303-1401
(770) 994-9326
(770) 994-4747
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
036-117579
IL
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
56453
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036117579
BLUE SHIELD
IL
05
—
036117579
—
IL
05
—
036117579-1
—
IL
Enumeration date
11/21/2006
Last updated
04/08/2013
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