Healthcare Provider Details

I. General information

NPI: 1851210082
Provider Name (Legal Business Name): EDITH KAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 W PONCE DE LEON AVE STE 375
DECATUR GA
30030-2633
US

IV. Provider business mailing address

315 W PONCE DE LEON AVE STE 375
DECATUR GA
30030-2633
US

V. Phone/Fax

Practice location:
  • Phone: 404-913-0766
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: