Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 2011-00642 | NC |
Y | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | 36680 | SC |
NPI | 1346446648 |
---|---|
Provider Name | Autumn Lynn Edenfield |
First Address | Charlotte, NC 28275-1461 |
Second Address | Charleston, SC 29425-8908 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2007 |
Last Update Date | 30/10/2020 |