Provider Demographics
NPI:1902691421
Name:EDMOND-CARROLL, DONNA
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:EDMOND-CARROLL
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 HOWARD LN STE G
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30215-1853
Mailing Address - Country:US
Mailing Address - Phone:404-219-7193
Mailing Address - Fax:
Practice Address - Street 1:125 HOWARD LN STE G
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30215-1853
Practice Address - Country:US
Practice Address - Phone:404-219-7193
Practice Address - Fax:404-254-4772
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-14
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA253J00000X, 343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No253J00000XAgenciesFoster Care Agency