Provider Demographics
NPI:1831291566
Name:EDWARDS, NICOLE J (DC)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:J
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1283 PARKWOOD CHASE NW
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30102-3472
Mailing Address - Country:US
Mailing Address - Phone:989-708-9029
Mailing Address - Fax:
Practice Address - Street 1:3362 ACWORTH SUMMIT BLVD NW
Practice Address - Street 2:
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30101-5770
Practice Address - Country:US
Practice Address - Phone:678-996-0373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008649111N00000X
GACHIR008211111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIU98095Medicare UPIN