Provider Demographics
NPI:1598246878
Name:LEDBETTER, EMMA
Entity Type:Individual
Prefix:MRS
First Name:EMMA
Middle Name:
Last Name:LEDBETTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1910 ELM PARK DR
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:GA
Mailing Address - Zip Code:30228-5518
Mailing Address - Country:US
Mailing Address - Phone:706-601-1832
Mailing Address - Fax:
Practice Address - Street 1:1910 ELM PARK DR
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:GA
Practice Address - Zip Code:30228
Practice Address - Country:US
Practice Address - Phone:706-601-1832
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-24
Last Update Date:2018-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN248471363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GARN248471OtherAMERICAN ASSOCIATION OF NURSE PRACTITIONERS