Basic Information
| Provider Information | |||||||||
| NPI: | 1427220615 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EDWARDS | ||||||||
| FirstName: | JANET | ||||||||
| MiddleName: | |||||||||
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| Credential: | AU.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 800 OAK RIDGE TPKE | ||||||||
| Address2: | SUITE C-101 | ||||||||
| City: | OAK RIDGE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 378306957 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8654821086 | ||||||||
| FaxNumber: | 8654824400 | ||||||||
| Practice Location | |||||||||
| Address1: | 800 OAK RIDGE TPKE | ||||||||
| Address2: | SUITE C-101 | ||||||||
| City: | OAK RIDGE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 378306957 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8654821086 | ||||||||
| FaxNumber: | 8654824400 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2008 | ||||||||
| LastUpdateDate: | 10/14/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | A0000000236 | TN | Y | Speech, Language and Hearing Service Providers | Audiologist |
ID Information
| ID | Type | State | Issuer | Description | 3192024 | 05 | TN | MEDICAID |