Provider Demographics
NPI:1366564908
Name:DUNCAN, EDNITA
Entity type:Individual
Prefix:
First Name:EDNITA
Middle Name:
Last Name:DUNCAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1741 NEWNAN CROSSING BLVD E
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30265-1599
Mailing Address - Country:US
Mailing Address - Phone:470-485-4393
Mailing Address - Fax:
Practice Address - Street 1:1741 NEWNAN CROSSING BLVD E
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-1599
Practice Address - Country:US
Practice Address - Phone:470-485-4393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN92001041C0700X
GACSW0086391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical