Provider Demographics
NPI:1508429531
Name:EDWARDS PSYCHOLOGICAL ASSOCIATES
Entity Type:Organization
Organization Name:EDWARDS PSYCHOLOGICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:MOFFITT
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:404-550-5879
Mailing Address - Street 1:1409 N HIGHLAND AVE NE STE J
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30306-3300
Mailing Address - Country:US
Mailing Address - Phone:404-550-5879
Mailing Address - Fax:
Practice Address - Street 1:1409 N HIGHLAND AVE NE STE J
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30306-3300
Practice Address - Country:US
Practice Address - Phone:404-550-5879
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-16
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty