Individual
EDWARD D KOONCE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
620 SKYLINE DR, JACKSON, TN 38301-3923
(731) 541-5000
Mailing address
1804 HIGHWAY 45 BYP STE 100, JACKSON, TN 38305-4436
(731) 664-4220
Taxonomy
Speciality
Code
Description
License number
State
207RH0002X
Hospice and Palliative Medicine (Internal Medicine) Physician
Primary
14984
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3014037
—
TN
01
—
3068372
BCBS
—
01
—
930124254
RR MEDICARE
TN
Enumeration date
01/12/2006
Last updated
02/28/2020
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