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General NPI Number Information
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NPI Number | 1639173248
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Entity Type | Individual
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Provider Name | EDWARD DAVID HIMOT M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/10/2005
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Last Update Date | 08/01/2019
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Provider Practice Location Address
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Address Line | 55 WHITCHER ST NE STE 460
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City | MARIETTA
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State | GA
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Zip | 30060-1171
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Country | US
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Telephone | 770-427-7389
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Fax | 770-427-2845
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Provider Business Mailing Address
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Address Line | 55 WHITCHER ST NE STE 460
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City | MARIETTA
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State | GA
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Zip | 30060-1171
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Country | US
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Telephone | 770-427-7389
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Fax | 770-427-2845
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 018388
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | GA018388
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License Number State | GA
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