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General NPI Number Information
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NPI Number | 1598715856
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Entity Type | Individual
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Provider Name | CARRIE LYNN EDWARDS
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Gender | Female
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Dates
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Enumeration Date | 05/10/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 11 UPPER RIVERDALE RD SW
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City | RIVERDALE
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State | GA
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Zip | 30274-2615
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Country | US
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Telephone | 770-994-9326
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Fax | 770-994-4747
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Provider Business Mailing Address
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Address Line | 1745 PHOENIX BLVD SUITE 100
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City | ATLANTA
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State | GA
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Zip | 30349-5591
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Country | US
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Telephone | 770-994-9326
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Fax | 770-994-4747
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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 | 207PE0004X
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Taxonomy Name | Emergency Medical Services (Emergency Medicine) Physician
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License Number | 054774
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License Number State | GA
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