Provider Demographics
NPI:1871667469
Name:EDMONDS, JANE ELIZABETH (PHD)
Entity Type:Individual
Prefix:DR
First Name:JANE
Middle Name:ELIZABETH
Last Name:EDMONDS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:215 HAWTHORNE PARK
Mailing Address - Street 2:SUITE B
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-2164
Mailing Address - Country:US
Mailing Address - Phone:706-549-1169
Mailing Address - Fax:706-227-8971
Practice Address - Street 1:215 HAWTHORNE PARK
Practice Address - Street 2:SUITE B
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-2164
Practice Address - Country:US
Practice Address - Phone:706-549-1169
Practice Address - Fax:706-227-8971
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA2135103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA10034720OtherAMERIGROUP