Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | RN134734NP | GA |
NPI | 1306060801 |
---|---|
Provider Name | Ms. Crystal M Edds |
First Address | Swainsboro, GA 30401-3234 |
Second Address | Swainsboro, GA 30401-3234 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2007 |
Last Update Date | 04/01/2010 |