Healthcare Provider Details

I. General information

NPI: 1194022939
Provider Name (Legal Business Name): EMILY JOHANNA EDWARDS RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2011
Last Update Date: 02/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 24TH AVE S
NASHVILLE TN
37212-2637
US

IV. Provider business mailing address

6017 PLEASANT HILL DR
PLEASANT VIEW TN
37146-7013
US

V. Phone/Fax

Practice location:
  • Phone: 615-873-7120
  • Fax:
Mailing address:
  • Phone: 615-587-2948
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number5930
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: