Healthcare Provider Details

I. General information

NPI: 1023353497
Provider Name (Legal Business Name): ALESHA MICHELLE EDWARDS D.P.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2012
Last Update Date: 04/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 SMITH ST
TENNILLE GA
31089-1465
US

IV. Provider business mailing address

2251 W ELM ST P O BOX 371
WRIGHTSVILLE GA
31096-2017
US

V. Phone/Fax

Practice location:
  • Phone: 478-864-3448
  • Fax: 478-864-1288
Mailing address:
  • Phone: 478-864-3448
  • Fax: 478-864-1288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPOD001216
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: