Provider Demographics
NPI:1033676937
Name:ALETHA LAKAY EDISON M D LLC
Entity type:Organization
Organization Name:ALETHA LAKAY EDISON M D LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ALETHA
Authorized Official - Middle Name:L
Authorized Official - Last Name:EDISON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-350-4999
Mailing Address - Street 1:1416 6TH AVE SE UNIT D
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35601-4247
Mailing Address - Country:US
Mailing Address - Phone:256-350-4999
Mailing Address - Fax:256-580-5818
Practice Address - Street 1:1416 6TH AVE SE UNIT D
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601-4247
Practice Address - Country:US
Practice Address - Phone:256-350-4999
Practice Address - Fax:256-580-5818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-27
Last Update Date:2019-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Single Specialty