Provider Demographics
NPI:1407610678
Name:EDWARDS, DEANNA (LPN095757)
Entity Type:Individual
Prefix:MRS
First Name:DEANNA
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:LPN095757
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:159 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:FAIRMOUNT
Mailing Address - State:GA
Mailing Address - Zip Code:30139-3248
Mailing Address - Country:US
Mailing Address - Phone:706-676-1480
Mailing Address - Fax:
Practice Address - Street 1:159 SPRING ST
Practice Address - Street 2:
Practice Address - City:FAIRMOUNT
Practice Address - State:GA
Practice Address - Zip Code:30139-3248
Practice Address - Country:US
Practice Address - Phone:706-676-1480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-08
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPN095757164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse