Active NPI
Keyairra Edlow
- Technician
- Fayetteville, GA
National Provider Identifier
1639940075
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Technician
- Practice address
- 101 Beckett LN Ste 202
Fayetteville, GA 30214-7157 - Phone
- (215) 694-8080
- NPI assigned
- Jan 15, 2024
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Technician | 374700000X | Primary |
Addresses
Primary practice location
101 Beckett LN Ste 202
Fayetteville, GA 30214-7157
Mailing address
4179 Leidy Ave
Philadelphia, PA 19104-1014
Phone (267) 581-8300
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1705276800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1705276800000",
"number": "1639940075",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4179 LEIDY AVE",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191041014",
"telephone_number": "267-581-8300"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "101 BECKETT LN STE 202",
"city": "FAYETTEVILLE",
"state": "GA",
"postal_code": "302147157",
"telephone_number": "215-694-8080"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EDLOW",
"first_name": "KEYAIRRA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-01-15",
"last_updated": "2024-01-15",
"certification_date": "2024-01-13",
"status": "A"
},
"taxonomies": [
{
"code": "374700000X",
"taxonomy_group": "",
"desc": "Technician",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fayetteville, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.