Provider Demographics
NPI:1225923949
Name:EDWARDS, JENETTE KIRSTINE
Entity type:Individual
Prefix:
First Name:JENETTE
Middle Name:KIRSTINE
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:375 CEMETERY RD
Mailing Address - Street 2:
Mailing Address - City:LYERLY
Mailing Address - State:GA
Mailing Address - Zip Code:30730-3005
Mailing Address - Country:US
Mailing Address - Phone:706-978-1889
Mailing Address - Fax:
Practice Address - Street 1:375 CEMETERY RD
Practice Address - Street 2:
Practice Address - City:LYERLY
Practice Address - State:GA
Practice Address - Zip Code:30730-3005
Practice Address - Country:US
Practice Address - Phone:706-978-1889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-11
Last Update Date:2025-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAJED-104159374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Multi-Specialty