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General NPI Number Information
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NPI Number | 1063280857
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Entity Type | Individual
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Provider Name | CARRIE MARIE EDGE MC
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Gender | Female
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Dates
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Enumeration Date | 12/12/2023
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Last Update Date | 12/12/2023
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Provider Practice Location Address
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Address Line | 701 E 2ND AVE SW
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City | ROME
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State | GA
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Zip | 30161-6101
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Country | US
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Telephone | 706-413-2421
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Fax |
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Provider Business Mailing Address
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Address Line | 67 SHADY LN SE
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City | ROME
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State | GA
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Zip | 30161-8421
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Country | US
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Telephone | 706-936-2917
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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