Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | DN010541 | GA |
NPI | 1710071667 |
---|---|
Provider Name | Vanessa A Edwards-Downer |
First Address | Columbus, GA 31904-8725 |
Second Address | Columbus, GA 31904-8725 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000376912D | (05) | GA |