Gregory Eugene Edwards

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

FCL-098-014 Issued in NC

Practice address

516 Deans St W
Wilson, NC 27893-2802

Phone

(252) 399-7069

Fax

(252) 291-9448

NPI assigned

Mar 13, 2007

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Gregory E Edwards

  • Assisted Living Facility
  • Wilson, NC
  • NPI 1285817205
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1173744000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1215069240",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "516 DEANS ST W",
            "city": "WILSON",
            "state": "NC",
            "postal_code": "278932802",
            "telephone_number": "252-399-7069",
            "fax_number": "252-291-9448"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "516 DEANS ST W",
            "city": "WILSON",
            "state": "NC",
            "postal_code": "278932802",
            "telephone_number": "252-399-7069",
            "fax_number": "252-291-9448"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EDWARDS",
        "first_name": "GREGORY",
        "middle_name": "EUGENE",
        "name_prefix": "Mr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-13",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "NC",
            "license": "FCL-098-014",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7804541",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Bradley Shane Edwards, COTA
• Ohiosumuan Chibuikem Ehimiaghe, DMD
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• Eiccua LLC
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• Rebecca L Eichner, DPT

• All providers in Wilson, NC
• Assisted Living Facility in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.