Provider Demographics
NPI:1790028173
Name:JAMA GAIL EDWARDS MD PC
Entity type:Organization
Organization Name:JAMA GAIL EDWARDS MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMA
Authorized Official - Middle Name:GAIL
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-873-8065
Mailing Address - Street 1:PO BOX 645
Mailing Address - Street 2:
Mailing Address - City:ZIONSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46077-0645
Mailing Address - Country:US
Mailing Address - Phone:317-873-8065
Mailing Address - Fax:
Practice Address - Street 1:1555 W OAK ST STE 100-2
Practice Address - Street 2:
Practice Address - City:ZIONSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46077-1896
Practice Address - Country:US
Practice Address - Phone:317-873-8065
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-03
Last Update Date:2018-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01036111261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care