NPIMap

Organization Active NPI

Edg Sports Medicine,Inc

  • Surgical Physician Assistant
  • Decatur, GA
National Provider Identifier
1114169703
Registry record updated Mar 30, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
1857 Issued in GA
Legal business name
EDG SPORTS MEDICINE,INC
Practice address
2801 N Decatur Rd
Suite 200
Decatur, GA 30033-5949
Phone
(404) 296-5005
Fax
(404) 296-5058
NPI assigned
Mar 30, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 30, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Eric Gaines
Title
Owner
Phone
(404) 296-5005

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician AssistantGroup: 193400000X SINGLE SPECIALTY GROUP 363AS0400X 1857 GA Primary

Addresses

Primary practice location

2801 N Decatur Rd
Suite 200
Decatur, GA 30033-5949

Mailing address

1230 Briarvista Way
Atlanta, GA 30329
Phone (404) 296-5005

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1238371200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1238371200000",
    "number": "1114169703",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1230 BRIARVISTA WAY",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "30329",
            "telephone_number": "404-296-5005",
            "fax_number": "404-296-5058"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2801 N DECATUR RD",
            "address_2": "SUITE 200",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300335949",
            "telephone_number": "404-296-5005",
            "fax_number": "404-296-5058"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDG SPORTS MEDICINE,INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-03-30",
        "last_updated": "2009-03-30",
        "status": "A",
        "authorized_official_last_name": "GAINES",
        "authorized_official_first_name": "ERIC",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "404-296-5005"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physician Assistant, Surgical",
            "state": "GA",
            "license": "1857",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Decatur, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.