Provider Demographics
NPI:1912533530
Name:EDWARDS, ABIGAIL (NP)
Entity Type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 W PONCE DE LEON AVE STE 380
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-2476
Mailing Address - Country:US
Mailing Address - Phone:404-492-8456
Mailing Address - Fax:
Practice Address - Street 1:315 W. PONE DE LEON AVE
Practice Address - Street 2:SUITE 380
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030
Practice Address - Country:US
Practice Address - Phone:404-492-8456
Practice Address - Fax:657-439-4533
Is Sole Proprietor?:No
Enumeration Date:2020-03-15
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN231762363LC1500X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LC1500XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCommunity Health