| Doctor Name: | EDNA SHARIE MOCK |
| NPI Number: | 1124458476 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | CERT HAIR LOSS SPECI |
| License Number: | CO116503 |
| Business Practice Address: | 2956 Vine Grove St Powder Springs, GA - 301271782 |
| Business Phone Number: | 7709903944 |
| Business Fax Number: | 7704398870 |
| Mailing Address: | 2956 Vine Grove St, POWDER SPRINGS |
| State: | GA |
| Postal Code: | 301271782 |
| Phone Number: | 7709903944 |
| Fax Number: | 7704398870 |
| NPI Enumeration Date: | 11/24/2013 |
| NPI Last Update Date: | 11/24/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1744P3200X |
| License Number: | CO116503 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Specialist |
| Taxonomy Specialization: | Prosthetics Case Management |
| Taxonomy Definition: | |