Provider Demographics
NPI:1558516336
Name:NASH, EDWIN W JR
Entity Type:Individual
Prefix:MR
First Name:EDWIN
Middle Name:W
Last Name:NASH
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3691 NORWICH DR
Mailing Address - Street 2:
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-3916
Mailing Address - Country:US
Mailing Address - Phone:770-333-6592
Mailing Address - Fax:770-938-5352
Practice Address - Street 1:122 CHERRY ST NE
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-7206
Practice Address - Country:US
Practice Address - Phone:770-333-6592
Practice Address - Fax:770-938-5352
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-20
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NO LICENSE PROVIDED101YP1600X
GA000887101YP2500X
GA000500106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist