Provider Demographics
NPI:1295406627
Name:EDMONDSON, KARYN CONNELL
Entity Type:Individual
Prefix:
First Name:KARYN
Middle Name:CONNELL
Last Name:EDMONDSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 ROSE ST STE B
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30907-2391
Mailing Address - Country:US
Mailing Address - Phone:706-364-4365
Mailing Address - Fax:
Practice Address - Street 1:300 ROSE ST STE B
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30907-2391
Practice Address - Country:US
Practice Address - Phone:706-364-4365
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-24
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347E00000XTransportation ServicesTransportation Broker