Organization
EDG SPORTS MEDICINE,INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ERIC GAINES (OWNER)
(404) 296-5005
Entity
Organization
Contact information
Practice address
2801 N DECATUR RD, SUITE 200, DECATUR, GA 30033-5949
(404) 296-5005
(404) 296-5058
Mailing address
1230 BRIARVISTA WAY, ATLANTA, GA 30329
(404) 296-5005
(404) 296-5058
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
1857
GA
Other
Enumeration date
03/30/2009
Last updated
03/30/2009
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