Provider Demographics
NPI:1154469161
Name:EDMONDS, GEORGE HENRY (BS, QP)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:HENRY
Last Name:EDMONDS
Suffix:
Gender:M
Credentials:BS, QP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 LIBERTY RD.
Mailing Address - Street 2:
Mailing Address - City:CANDLER
Mailing Address - State:NC
Mailing Address - Zip Code:28715-8421
Mailing Address - Country:US
Mailing Address - Phone:828-712-8629
Mailing Address - Fax:
Practice Address - Street 1:411 LIBERTY RD
Practice Address - Street 2:
Practice Address - City:CANDLER
Practice Address - State:NC
Practice Address - Zip Code:28715-8421
Practice Address - Country:US
Practice Address - Phone:828-712-8629
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2009-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health