Individual
EDNECIA FITZPATRICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6107 BROADWING RD, TRUSSVILLE, AL 35173-6314
(404) 442-5001
Mailing address
6107 BROADWING RD, TRUSSVILLE, AL 35173-6314
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
—
—
251E00000X
Home Health Agency
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
343900000X
Non-emergency Medical Transport (VAN)
—
—
376G00000X
Nursing Home Administrator
—
—
385H00000X
Respite Care
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
85-1764905
—
AL
Enumeration date
11/17/2020
Last updated
11/17/2020
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