Provider Demographics
NPI:1831192947
Name:HORWITZ, EDWIN (MD)
Entity type:Individual
Prefix:
First Name:EDWIN
Middle Name:
Last Name:HORWITZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1405 CLIFTON RD NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30322-1060
Mailing Address - Country:US
Mailing Address - Phone:404-785-1112
Mailing Address - Fax:404-785-6288
Practice Address - Street 1:1405 CLIFTON RD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322-1060
Practice Address - Country:US
Practice Address - Phone:404-785-1112
Practice Address - Fax:404-785-6288
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA802172080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR134202001Medicaid
KY64926868Medicaid
NE100249681-00Medicaid
OH2004477Medicaid
NC7611306Medicaid
AL009912810Medicaid
MO205027907Medicaid
MS00117967Medicaid
NY02139999-03Medicaid
IA0537761Medicaid
OK100046870AMedicaid
MI104823428Medicaid
IN200179680AMedicaid
ME422400000Medicaid
KS200377090AMedicaid
LA1544566Medicaid
TN3808704Medicaid
KS200377090AMedicaid
IN200179680AMedicaid