MEDICARE: DR. LAUREN MOFFITT EDWARDS PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist

General Provider Information

NPI Number	:	1801190178
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAUREN MOFFITT EDWARDS PH.D.

Provider Business Mailing Address
First Line	:	1409 N HIGHLAND AVE NE STE J
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30306-3300
Country	:	US
Telephone Number	:	404-550-5879
Fax Number	:

Provider Business Practice Location Address
First Line	:	1409 N HIGHLAND AVE NE STE J
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30306-3300
Country	:	US
Telephone Number	:	404-550-5879
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/30/2010
Last Update Date	:	04/16/2019

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