Provider Demographics
NPI:1538306709
Name:GEORGIA ELECTRO DIAGNOSTIC PROVIDERS P.C.
Entity Type:Organization
Organization Name:GEORGIA ELECTRO DIAGNOSTIC PROVIDERS P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:E
Authorized Official - Last Name:WINDSOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-850-8464
Mailing Address - Street 1:2550 WINDY HILL RD
Mailing Address - Street 2:SUITE 215
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-8654
Mailing Address - Country:US
Mailing Address - Phone:770-850-8464
Mailing Address - Fax:770-850-9727
Practice Address - Street 1:2550 WINDY HILL RD
Practice Address - Street 2:SUITE 215
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-8654
Practice Address - Country:US
Practice Address - Phone:770-850-8464
Practice Address - Fax:770-850-9727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-09
Last Update Date:2009-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000476968KMedicaid
GA000476968KMedicaid