Healthcare Provider Details

I. General information

NPI: 1265184113
Provider Name (Legal Business Name): DAISY EDWARDS RN, RNFA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/21/2022
Last Update Date: 01/21/2022
Certification Date: 01/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 NORTHSIDE FORSYTH DR
CUMMING GA
30041-7659
US

IV. Provider business mailing address

5535 PRESERVE PT
FLOWERY BRANCH GA
30542-6111
US

V. Phone/Fax

Practice location:
  • Phone: 770-844-3200
  • Fax:
Mailing address:
  • Phone: 678-643-9065
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License NumberRN223259
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: