| Organization Name: | EDGEWOOD MEDICAL CENTER INC |
| NPI Number: | 1801199914 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | GHOLAM REZA BAKHTIARI (PRESIDENT) |
| Mailing Address: | 212 Edgewood Ave Ne Atlanta |
| State: | GA US |
| Postal Code: | 30303 |
| Phone Number: | 4042460589 |
| Fax Number: | 4046882226 |
| NPI Enumeration Date: | 12/10/2010 |
| NPI Last Update Date: | 12/10/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 253Z00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Agencies |
| Taxonomy Classification: | In Home Supportive Care |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An In Home Supportive Care Agency provides services in the patient |