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General NPI Number Information
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NPI Number | 1972839637
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Entity Type | Individual
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Provider Name | MRS. PATRICIA ELIZABETH EDWARDS
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Gender | Female
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Dates
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Enumeration Date | 10/30/2009
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Last Update Date | 10/30/2009
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Provider Practice Location Address
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Address Line | 4640 MARTIN RD
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City | CUMMING
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State | GA
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Zip | 30041-5533
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Country | US
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Telephone | 678-679-1261
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Fax | 678-679-1265
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Provider Business Mailing Address
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Address Line | 6245 NIX RD
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City | DAWSONVILLE
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State | GA
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Zip | 30534-4711
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Country | US
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Telephone | 770-889-1737
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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 | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SLP000856
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License Number State | GA
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