Healthcare Provider Details

I. General information

NPI: 1902691421
Provider Name (Legal Business Name): DONNA EDMOND-CARROLL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2025
Last Update Date: 04/14/2025
Certification Date: 04/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 HOWARD LN STE G
FAYETTEVILLE GA
30215-1853
US

IV. Provider business mailing address

125 HOWARD LN STE G
FAYETTEVILLE GA
30215-1853
US

V. Phone/Fax

Practice location:
  • Phone: 404-219-7193
  • Fax: 404-254-4772
Mailing address:
  • Phone: 404-219-7193
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: