Provider Demographics
NPI:1538165865
Name:EDWARDS, TONYA DENEEN (MD)
Entity type:Individual
Prefix:MS
First Name:TONYA
Middle Name:DENEEN
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:304 ASHBY PARK LN
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-6908
Mailing Address - Country:US
Mailing Address - Phone:864-286-9050
Mailing Address - Fax:864-286-6885
Practice Address - Street 1:304 ASHBY PARK LN
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-6908
Practice Address - Country:US
Practice Address - Phone:864-286-9050
Practice Address - Fax:864-286-6885
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2007-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC15466207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E94164Medicare UPIN