Provider Demographics
NPI:1144640566
Name:EDWARD, AMBER MARIE (CRNA)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:MARIE
Last Name:EDWARD
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:
Other - Last Name:STATEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1186
Mailing Address - Street 2:
Mailing Address - City:MABLETON
Mailing Address - State:GA
Mailing Address - Zip Code:30126-1003
Mailing Address - Country:US
Mailing Address - Phone:888-408-0200
Mailing Address - Fax:
Practice Address - Street 1:3193 HOWELL MILL RD NW STE 315
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30327-2100
Practice Address - Country:US
Practice Address - Phone:888-408-0200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-24
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9279560163W00000X
GARN276210367500000X
FLARNP9279560367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse