Provider Demographics
NPI:1265183677
Name:CHIN-EDWARDS, AVA MARIE (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:AVA
Middle Name:MARIE
Last Name:CHIN-EDWARDS
Suffix:
Gender:F
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 1:2505 WALNUT RIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-9211
Mailing Address - Country:US
Mailing Address - Phone:516-376-8586
Mailing Address - Fax:
Practice Address - Street 1:550 PEACHTREE ST NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308-2212
Practice Address - Country:US
Practice Address - Phone:404-778-4889
Practice Address - Fax:404-778-0826
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-17
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261Q00000X
GARN263923363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center