Edmondson, Marshall Gray

Edmondson, Marshall Gray is an individual health care provider with primary practice located at 620 Crossover Road , Tupelo MS 38801-4944. He recently has only one registered license in Allopathic & Osteopathic Physicians / Diagnostic Radiology, which is considered as his primary health care specialty. Edmondson, Marshall Gray can be contacted via phone (662) 620-7102.

Contact Information

Primary practice address
620 Crossover Road Tupelo MS 38801-4944
Phone: (662) 620-7102
Fax: (662) 620-7106
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Diagnostic Radiology 2085R0202X 06183 Mississippi

Profile Details

NPI number 1720026255
LBN Legal business name Edmondson, Marshall Gray
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 4th, 2006
Last updated Sep 26th, 2023 - about last year

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1720026255 NPPES
Mississippi MEDICAID 00014322
Mississippi MEDICAID 009700310
Mississippi Other 300020470

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