Provider Demographics
NPI:1427509165
Name:EDOUARD, RAYMOND (FNP-C)
Entity type:Individual
Prefix:
First Name:RAYMOND
Middle Name:
Last Name:EDOUARD
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6130 PRESTLEY MILL RD STE C
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30134-2288
Mailing Address - Country:US
Mailing Address - Phone:678-838-3903
Mailing Address - Fax:678-838-7454
Practice Address - Street 1:6130 PRESTLEY MILL RD STE C
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30134-2288
Practice Address - Country:US
Practice Address - Phone:678-838-3903
Practice Address - Fax:678-838-7454
Is Sole Proprietor?:No
Enumeration Date:2016-10-18
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN205315363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health