Provider Demographics
NPI:1730530502
Name:EDWARDS, KENT RUSSELL JR
Entity type:Individual
Prefix:DR
First Name:KENT
Middle Name:RUSSELL
Last Name:EDWARDS
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:169 ASHLEY AVE
Mailing Address - Street 2:ROOM 202 MAIN HOSPITAL
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29425-8905
Mailing Address - Country:US
Mailing Address - Phone:843-792-3072
Mailing Address - Fax:
Practice Address - Street 1:401 MULBERRY ST SW STE 202
Practice Address - Street 2:
Practice Address - City:LENOIR
Practice Address - State:NC
Practice Address - Zip Code:28645-5463
Practice Address - Country:US
Practice Address - Phone:828-757-6464
Practice Address - Fax:828-757-6424
Is Sole Proprietor?:No
Enumeration Date:2016-06-23
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLL39777208800000X
NC2020-04205208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology