Individual
KELLY EDWARDS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
305 OAK CENTER PL, VALDOSTA, GA 31602-1678
(706) 840-4671
Mailing address
305 OAK CENTER PL, VALDOSTA, GA 31602-1678
(706) 840-4671
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
11029685
FL
363LF0000X
Family Nurse Practitioner
Primary
RN290241
GA
Other
Enumeration date
12/12/2023
Last updated
12/12/2023
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