# EDGEWOOD MEDICAL CENTER INC

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

## Provider details

- **NPI number:** 1801199914
- **Authorized official:** DR. GHOLAM REZA BAKHTIARI PHARMD (PRESIDENT)
- **Authorized official phone:** (404) 688-2211

## Contact information

- **Practice address:** 212 EDGEWOOD AVE NE, ATLANTA, GA 30303
- **Practice address phone:** (404) 246-0589
- **Practice address fax:** (404) 688-2226
- **Mailing address:** 212 EDGEWOOD AVE NE, ATLANTA, GA 30303-3027
- **Mailing address phone:** (404) 246-0589
- **Mailing address fax:** (404) 688-2226

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 253Z00000X | In Home Supportive Care Agency | — | NULL | — |
| 261QM1300X | Multi-Specialty Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 12/10/2010
- **Last updated:** 12/10/2010