Provider Demographics
NPI:1770065146
Name:EDENFIELD, MAGGIE ALYSSA (ATC)
Entity type:Individual
Prefix:
First Name:MAGGIE
Middle Name:ALYSSA
Last Name:EDENFIELD
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 CLEARVIEW CIR
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-2700
Mailing Address - Country:US
Mailing Address - Phone:770-335-9698
Mailing Address - Fax:
Practice Address - Street 1:190 CLEARVIEW CIR
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-2700
Practice Address - Country:US
Practice Address - Phone:770-335-9698
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-03
Last Update Date:2018-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer