Healthcare Provider Details

I. General information

NPI: 1336112762
Provider Name (Legal Business Name): CATHY BERNICE EDMUNDS
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3421 MIKE PADGETT HWY
AUGUSTA GA
30906-3815
US

IV. Provider business mailing address

2240 RED HAVEN DR
THOMSON GA
30824-4739
US

V. Phone/Fax

Practice location:
  • Phone: 706-595-2739
  • Fax: 706-595-1661
Mailing address:
  • Phone: 706-595-2739
  • Fax: 706-595-1661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN085102
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: