Provider Demographics
NPI:1235729633
Name:EDWARDS, TAMYRA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:TAMYRA
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 BOMBAY LN STE B
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-5814
Mailing Address - Country:US
Mailing Address - Phone:678-824-7733
Mailing Address - Fax:
Practice Address - Street 1:104 BOMBAY LN STE B
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-5814
Practice Address - Country:US
Practice Address - Phone:678-824-7733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-20
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY004399103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical