Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | POD001216 | GA |
NPI | 1023353497 |
---|---|
Provider Name | Alesha Michelle Edwards |
First Address | Wrightsville, GA 31096-2017 |
Second Address | Tennille, GA 31089-1465 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/12/2012 |
Last Update Date | 03/04/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
POD001216 | LICENSE (01) | GA |