Healthcare Provider Details

I. General information

NPI: 1265160642
Provider Name (Legal Business Name): KATRINA LAVETTE EDWARDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2022
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

154 BROOKVIEW DR
NEWNAN GA
30265-5715
US

IV. Provider business mailing address

154 BROOKVIEW DR
NEWNAN GA
30265-5715
US

V. Phone/Fax

Practice location:
  • Phone: 256-225-4371
  • Fax:
Mailing address:
  • Phone: 256-225-4371
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number314794
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: