Individual provider · NPI-1

Jaquon Edwards

Technician · Marietta, GA

NPI number1134032345
StatusActive
Last updated in NPPESSep 28, 2026

Details

NPI
1134032345
Entity type
Individual (NPI-1)
Name
Jaquon Edwards
Sex
Male
Sole proprietor
Yes
Enumeration date
Sep 28, 2026
Certification date
Sep 28, 2026
Last updated
Sep 28, 2026

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
374700000X Technician––Yes

Practice location

899 Powers Ferry Rd Se Apt E3
Marietta, GA 30067-5767

Phone 662-616-0595

Mailing address

899 Powers Ferry Rd Se Apt E3
Marietta, GA 30067-5767

Phone 662-616-0595

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