Provider Demographics
NPI:1033561956
Name:EDENS HEALTH GROUP LAWRENCEVILLE
Entity Type:Organization
Organization Name:EDENS HEALTH GROUP LAWRENCEVILLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:ALTON
Authorized Official - Last Name:EDENS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:855-491-8869
Mailing Address - Street 1:PO BOX 629
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:GA
Mailing Address - Zip Code:31069-0629
Mailing Address - Country:US
Mailing Address - Phone:855-691-8869
Mailing Address - Fax:855-691-8879
Practice Address - Street 1:2011 COMMERCE DR N
Practice Address - Street 2:SUITE 25
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-3538
Practice Address - Country:US
Practice Address - Phone:770-317-7773
Practice Address - Fax:855-491-8879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-02
Last Update Date:2016-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAPENDINGMedicare PIN