Provider Demographics
NPI:1700482668
Name:ABNEY, EDNA PAIGE
Entity Type:Individual
Prefix:
First Name:EDNA
Middle Name:PAIGE
Last Name:ABNEY
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 1:1640 POWERS FERRY RD SE BLDG 18-350
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-1432
Mailing Address - Country:US
Mailing Address - Phone:800-762-5945
Mailing Address - Fax:
Practice Address - Street 1:1640 POWERS FERRY RD SE BLDG 18-350
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-1432
Practice Address - Country:US
Practice Address - Phone:800-762-5945
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-07
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMFT001826106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty