Basic Information
| Provider Information | |||||||||
| NPI: | 1225321748 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EDWARDS | ||||||||
| FirstName: | MARLISHA | ||||||||
| MiddleName: | T | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1300 MEDICAL DR | ||||||||
| Address2: | |||||||||
| City: | TALLAHASSEE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 323084646 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8502160100 | ||||||||
| FaxNumber: | 8502160180 | ||||||||
| Practice Location | |||||||||
| Address1: | 1300 MEDICAL DR | ||||||||
| Address2: | |||||||||
| City: | TALLAHASSEE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 323084646 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8502160100 | ||||||||
| FaxNumber: | 8502160180 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/17/2011 | ||||||||
| LastUpdateDate: | 12/26/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/26/2019 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 51827 | SC | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | E11135 | AR | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 2018-00073 | NC | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 51039 | KY | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 080003 | GA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | ME114065 | FL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.