Individual
EDSWORTH S JOHN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1255 HIGHWAY 54 W, FAYETTEVILLE, GA 30214
(404) 367-3014
Mailing address
35 COLLIER RD NW STE 635, ATLANTA, GA 30309-1611
(404) 367-3014
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
65012
GA
208M00000X
Hospitalist Physician
Primary
65012
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003118434A
—
GA
01
—
53533635
BCBS OF GA
GA
05
—
GA1257
—
SC
Enumeration date
02/11/2007
Last updated
06/11/2018
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