Healthcare Provider Details

I. General information

NPI: 1750193231
Provider Name (Legal Business Name): LASHONA EADDY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2025
Last Update Date: 01/22/2025
Certification Date: 01/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1102 TREYMONT LN
LAWRENCEVILLE GA
30045-7815
US

IV. Provider business mailing address

1102 TREYMONT LN
LAWRENCEVILLE GA
30045-7815
US

V. Phone/Fax

Practice location:
  • Phone: 678-789-3532
  • Fax:
Mailing address:
  • Phone: 678-789-3532
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: