Basic Information
| Provider Information | |||||||||
| NPI: | 1932657541 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EDWARDS | ||||||||
| FirstName: | ALEX | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2809 FOREST HOME RD | ||||||||
| Address2: | |||||||||
| City: | JONESBORO | ||||||||
| State: | AR | ||||||||
| PostalCode: | 724015320 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8669721268 | ||||||||
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| Practice Location | |||||||||
| Address1: | 809 W MAIN ST STE C-D | ||||||||
| Address2: | |||||||||
| City: | TRUMANN | ||||||||
| State: | AR | ||||||||
| PostalCode: | 724722611 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8704830068 | ||||||||
| FaxNumber: | 8704830066 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/13/2016 | ||||||||
| LastUpdateDate: | 08/11/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/11/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 10115-M | AR | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.