Provider Demographics
NPI:1184349409
Name:EDWARDS, AINSLEY
Entity type:Individual
Prefix:MR
First Name:AINSLEY
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1860 SANDY PLAINS RD STE 204
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-7864
Mailing Address - Country:US
Mailing Address - Phone:678-886-1916
Mailing Address - Fax:
Practice Address - Street 1:5810 VININGS RETREAT CT SW
Practice Address - Street 2:
Practice Address - City:MABLETON
Practice Address - State:GA
Practice Address - Zip Code:30126-2548
Practice Address - Country:US
Practice Address - Phone:678-886-1916
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-10
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst