Healthcare Provider Details

I. General information

NPI: 1033031661
Provider Name (Legal Business Name): ASHLEY MCCOY EDENFIELD FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

257 N MAIN ST
WADLEY GA
30477-4962
US

IV. Provider business mailing address

257 N MAIN ST
WADLEY GA
30477-4962
US

V. Phone/Fax

Practice location:
  • Phone: 478-252-0027
  • Fax:
Mailing address:
  • Phone: 478-252-0027
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP213310
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: