Individual
MATTHEW JONATHAN EDWARDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1690 SKYLYN DR STE 210, SPARTANBURG, SC 29307-1075
(864) 253-8170
(864) 585-7787
Mailing address
PO BOX 743070, ATLANTA, GA 30374-3070
(864) 560-4304
(864) 560-4413
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
22918
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080180392
MEDICARE RAIL ROAD
SC
05
—
229185
—
SC
01
—
AA61386084
MEDICARE PIN
SC
Enumeration date
04/22/2006
Last updated
12/24/2020
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