Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC1500X | Nurse Practitioner - Community Health | RN231762 | GA |
NPI | 1912533530 |
---|---|
Provider Name | Abigail Edwards |
First Address | Lithonia, GA 30038-7743 |
Second Address | Decatur, GA 30030-1707 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/03/2020 |
Last Update Date | 15/03/2020 |