Provider Demographics
NPI:1467894386
Name:EDWARDS, DANIELLE (LMT, PT)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:LMT, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3353 PEACHTREE RD NE
Mailing Address - Street 2:SUITE T-01
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30326-1063
Mailing Address - Country:US
Mailing Address - Phone:678-552-4500
Mailing Address - Fax:
Practice Address - Street 1:2399 PARKLAND DR NE
Practice Address - Street 2:SUITE 1112
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30324-3557
Practice Address - Country:US
Practice Address - Phone:678-552-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-19
Last Update Date:2013-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT005406246Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other