Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | GA8493 | GA |
NPI | 1245396894 |
---|---|
Provider Name | Dr. Ken E Edwards III |
First Address | Norcross, GA 30093 |
Second Address | Duluth, GA 30096 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/12/2006 |
Last Update Date | 08/07/2007 |