Individual
DR. MARSHALL GRAY EDMONDSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
620 CROSSOVER ROAD, TUPELO, MS 38801-4944
(662) 620-7102
(662) 620-7106
Mailing address
POST OFFICE BOX 980, TUPELO, MS 38802-0980
(662) 620-7102
(662) 620-7106
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
06183
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00014322
—
MS
05
—
009700310
—
AL
01
—
300020470
RAILROAD MEDICARE
MS
Enumeration date
06/04/2006
Last updated
09/26/2023
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