Provider Demographics
NPI:1326244831
Name:EDMONDS, HOLLY DICKSON (MD)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:DICKSON
Last Name:EDMONDS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1800 HOWELL MILL RD NW
Mailing Address - Street 2:SUITE 680
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30318-2538
Mailing Address - Country:US
Mailing Address - Phone:404-352-1730
Mailing Address - Fax:404-352-6901
Practice Address - Street 1:1800 HOWELL MILL RD NW
Practice Address - Street 2:SUITE 680
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30318-2538
Practice Address - Country:US
Practice Address - Phone:404-352-1730
Practice Address - Fax:404-352-6907
Is Sole Proprietor?:No
Enumeration Date:2007-06-22
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2007018080207N00000X
GA63652207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology