Provider Demographics
NPI:1881573798
Name:EDWARDS, ILLIYAH PHYLLIS
Entity type:Individual
Prefix:
First Name:ILLIYAH
Middle Name:PHYLLIS
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3700 E KING HENRY DR
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29506-8621
Mailing Address - Country:US
Mailing Address - Phone:917-815-6395
Mailing Address - Fax:
Practice Address - Street 1:3700 E KING HENRY DR
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29506-8621
Practice Address - Country:US
Practice Address - Phone:917-815-6395
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-27
Last Update Date:2025-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC30844207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology