Healthcare Provider Details

I. General information

NPI: 1124912795
Provider Name (Legal Business Name): MS. DANELIA SMITH EDWARDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2025
Last Update Date: 06/06/2025
Certification Date: 06/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

812 GREENWOOD AVE
CLARKSVILLE TN
37040-4068
US

IV. Provider business mailing address

1007 MONICA DR
CLARKSVILLE TN
37042-6714
US

V. Phone/Fax

Practice location:
  • Phone: 931-920-7200
  • Fax:
Mailing address:
  • Phone: 931-395-8945
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number154039
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: