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NPI Code Detail

MEDICARE: FABIENNE EDOUARD

MEDICARE: FABIENNE EDOUARD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior TechnicianGA

General Provider Information

NPI Number : 1073363289
Entity Type Code : Individual
Provider Name (Legal Business Name) : FABIENNE EDOUARD
Provider Business Mailing Address
First Line : 1845 SATELLITE BLVD STE 800
Second Line :
City : DULUTH
State : GA
Zip : 30097-6286
Country : US
Telephone Number : 404-295-7941
Fax Number :
Provider Business Practice Location Address
First Line : 1845 SATELLITE BLVD STE 800
Second Line :
City : DULUTH
State : GA
Zip : 30097-6286
Country : US
Telephone Number : 404-295-7941
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/22/2024
Last Update Date : 03/22/2024

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Directions to “ FABIENNE EDOUARD ” Practice Location

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