Provider Demographics
NPI:1891591244
Name:EDGEWATER PAIN AND WELLNESS LLC
Entity type:Organization
Organization Name:EDGEWATER PAIN AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SEARCY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:334-333-3471
Mailing Address - Street 1:200 GROVE PARK LN STE 640
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36305-5912
Mailing Address - Country:US
Mailing Address - Phone:334-333-3471
Mailing Address - Fax:
Practice Address - Street 1:200 GROVE PARK LN STE 640
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36305-5912
Practice Address - Country:US
Practice Address - Phone:334-333-3471
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-24
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty