Provider Demographics
NPI:1598389710
Name:EDGE, TESA
Entity Type:Individual
Prefix:
First Name:TESA
Middle Name:
Last Name:EDGE
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 1:309 TANNER RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-5923
Mailing Address - Country:US
Mailing Address - Phone:864-640-0009
Mailing Address - Fax:864-558-0589
Practice Address - Street 1:309 TANNER RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-5923
Practice Address - Country:US
Practice Address - Phone:864-640-0009
Practice Address - Fax:864-558-0589
Is Sole Proprietor?:No
Enumeration Date:2020-06-03
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator