Provider Demographics
NPI:1427606847
Name:EDMUNDSON, ANN W (MD)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:W
Last Name:EDMUNDSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15685 ROWE RD
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:GA
Mailing Address - Zip Code:30004-2628
Mailing Address - Country:US
Mailing Address - Phone:404-784-6457
Mailing Address - Fax:
Practice Address - Street 1:15685 ROWE RD
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:GA
Practice Address - Zip Code:30004-2628
Practice Address - Country:US
Practice Address - Phone:404-784-6457
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-28
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA34580207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism