Provider Demographics
NPI:1851767214
Name:EDENFIELD, MICHAEL B (FNP-C)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:B
Last Name:EDENFIELD
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1143
Mailing Address - Street 2:
Mailing Address - City:SWAINSBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30401-1143
Mailing Address - Country:US
Mailing Address - Phone:478-494-0331
Mailing Address - Fax:
Practice Address - Street 1:401 W MAIN ST
Practice Address - Street 2:
Practice Address - City:SWAINSBORO
Practice Address - State:GA
Practice Address - Zip Code:30401-3110
Practice Address - Country:US
Practice Address - Phone:478-237-9928
Practice Address - Fax:478-237-4517
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-19
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN198693363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily