Provider Demographics
NPI:1801199914
Name:EDGEWOOD MEDICAL CENTER INC
Entity Type:Organization
Organization Name:EDGEWOOD MEDICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GHOLAM
Authorized Official - Middle Name:REZA
Authorized Official - Last Name:BAKHTIARI
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:404-688-2211
Mailing Address - Street 1:212 EDGEWOOD AVE NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30303-3027
Mailing Address - Country:US
Mailing Address - Phone:404-246-0589
Mailing Address - Fax:404-688-2226
Practice Address - Street 1:212 EDGEWOOD AVE NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30303
Practice Address - Country:US
Practice Address - Phone:404-246-0589
Practice Address - Fax:404-688-2226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-10
Last Update Date:2010-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No253Z00000XAgenciesIn Home Supportive Care