Provider Demographics
NPI:1952360265
Name:EDMONDS, ERICKA M (DDS)
Entity Type:Individual
Prefix:
First Name:ERICKA
Middle Name:M
Last Name:EDMONDS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:755 COMMERCE DR
Mailing Address - Street 2:STE. 513
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-2627
Mailing Address - Country:US
Mailing Address - Phone:404-377-7711
Mailing Address - Fax:404-377-6040
Practice Address - Street 1:3890 REDWINE RD SW
Practice Address - Street 2:SUITE 108
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-5582
Practice Address - Country:US
Practice Address - Phone:404-344-7645
Practice Address - Fax:404-574-6725
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-23
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0128331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice