Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NR0400X | Rehabilitation Chiropractor | CHIR010132 | GA |
N | 111NS0005X | Chiropractic Sports Physician | CHIR010132 | GA |
Y | 111NX0800X | Chiropractor Orthopedic Specialist | CHIR010132 | GA |
NPI | 1821564543 |
---|---|
Provider Name | Dr. Kenya Edwards |
First Address | Lithonia, GA 30058-5658 |
Second Address | Atlanta, GA 30311-3354 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/10/2018 |
Last Update Date | 20/10/2018 |