Provider Demographics
NPI:1508155276
Name:THE MEADOWS EDGE, LLC
Entity Type:Organization
Organization Name:THE MEADOWS EDGE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHELLEY
Authorized Official - Middle Name:B
Authorized Official - Last Name:HANKINS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:706-913-1774
Mailing Address - Street 1:110 W CRAWFORD ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720-4201
Mailing Address - Country:US
Mailing Address - Phone:706-913-1774
Mailing Address - Fax:706-529-4199
Practice Address - Street 1:110 W CRAWFORD ST
Practice Address - Street 2:SUITE 202
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-4201
Practice Address - Country:US
Practice Address - Phone:706-913-1774
Practice Address - Fax:706-529-4199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-04
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA4989261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA4989OtherLPC