Organization
EDGEWOOD MEDICAL CENTER INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GHOLAM REZA BAKHTIARI PHARMD (PRESIDENT)
(404) 688-2211
Entity
Organization
Contact information
Practice address
212 EDGEWOOD AVE NE, ATLANTA, GA 30303
(404) 246-0589
(404) 688-2226
Mailing address
212 EDGEWOOD AVE NE, ATLANTA, GA 30303-3027
(404) 246-0589
(404) 688-2226
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
—
—
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Enumeration date
12/10/2010
Last updated
12/10/2010
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