# EDG SPORTS MEDICINE,INC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1114169703
- **Authorized official:** ERIC GAINES (OWNER)
- **Authorized official phone:** (404) 296-5005

## Contact information

- **Practice address:** 2801 N DECATUR RD, SUITE 200, DECATUR, GA 30033-5949
- **Practice address phone:** (404) 296-5005
- **Practice address fax:** (404) 296-5058
- **Mailing address:** 1230 BRIARVISTA WAY, ATLANTA, GA 30329
- **Mailing address phone:** (404) 296-5005
- **Mailing address fax:** (404) 296-5058

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363AS0400X | Surgical Physician Assistant | 1857 | GA | Yes |

## Other

- **Enumeration date:** 03/30/2009
- **Last updated:** 03/30/2009