Provider Demographics
NPI:1205487725
Name:EDWARDS, URSULA JACINTA (LMT, CNMT)
Entity type:Individual
Prefix:
First Name:URSULA
Middle Name:JACINTA
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:LMT, CNMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 LANIER AVE W STE 411
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-7638
Mailing Address - Country:US
Mailing Address - Phone:404-765-0798
Mailing Address - Fax:
Practice Address - Street 1:500 LANIER AVE W STE 411
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-7638
Practice Address - Country:US
Practice Address - Phone:404-765-0798
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-25
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT003516172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist