MEDICARE: RONCEY DECOY EDMONDSON

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
1	175T00000X	Peer Specialist	000-2337	TN

General Provider Information

NPI Number	:	1619811437
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RONCEY DECOY EDMONDSON

Provider Business Mailing Address
First Line	:	609 WOLFEBORO LN
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37221-6616
Country	:	US
Telephone Number	:	615-218-4571
Fax Number	:

Provider Business Practice Location Address
First Line	:	609 WOLFEBORO LN
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37221-6616
Country	:	US
Telephone Number	:	615-218-4571
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/14/2026
Last Update Date	:	04/14/2026

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Directions to “ RONCEY DECOY EDMONDSON ” Practice Location

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