Provider Demographics
NPI:1598211625
Name:EDWARDS, KIMMI (PT)
Entity Type:Individual
Prefix:
First Name:KIMMI
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KIMESHA
Other - Middle Name:KARMARIA
Other - Last Name:EDWARDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:445 YOUNG JAMES CIR
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-1475
Mailing Address - Country:US
Mailing Address - Phone:404-513-8581
Mailing Address - Fax:
Practice Address - Street 1:445 YOUNG JAMES CIR
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-1475
Practice Address - Country:US
Practice Address - Phone:404-513-8581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-29
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC16590225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist