Individual
JACOB EDWARDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
350 WINN WAY, DECATUR, GA 30030-2106
(404) 508-1177
(404) 508-9640
Mailing address
1528 MONARCH DR, MARIETTA, GA 30062-2748
(404) 213-1581
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
MD.31940
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003190111D
—
GA
05
—
021006600
—
FL
05
—
141478
—
AL
05
—
229200
—
AL
01
—
51222367
BCBS
AL
Enumeration date
04/28/2009
Last updated
05/21/2025
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