Individual provider Active NPI

Brentan M Edwards, PAA

  • Anesthesiologist Assistant
  • Atlanta, GA
National Provider Identifier
1659467314
Registry record updated Feb 17, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiologist AssistantTaxonomy code 367H00000X
License
4856 Issued in GA
Practice address
1405 Clifton Rd NE FL 3
Atlanta, GA 30322-1060
Phone
(404) 785-6670
Fax
(404) 785-1362
NPI assigned
Oct 4, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 17, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiologist Assistant 367H00000X 4856 GA Primary

Addresses

Primary practice location

1405 Clifton Rd NE FL 3
Atlanta, GA 30322-1060

Mailing address

1405 Clifton Rd NE FL 3
Atlanta, GA 30322-1060
Phone (404) 785-6670

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address choa@choa.gadirect.net

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20070423000104 GA Practitioner - Anesthesiology Assistant 0648375535 Reassigns benefits to 1 organization
I20210608002282 GA Practitioner - Physician Assistant 0648375535 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Associate of Arts

State licenses

LicenseStateTypeSpecialty
004856GAMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Egleston Pediatric Group Current Accepting new patients
Choa Multispecialty, LLC Current Accepting new patients
Piedmont Anesthesia Associates, L.L.C Past Accepting new patients
Fayette Community Anesthesia Past Accepting new patients

Locations

1364 Clifton Rd NE
Atlanta, GA 30322
Phone (404) 712-7100

1405 Clifton Rd NE
Fl 3
Atlanta, GA 30322
Phone (404) 785-6670

1365 Clifton Rd NE
Atlanta, GA 30322
Phone (404) 778-7525

1405 Clifton Rd NE
Atlanta, GA 30322
Phone (404) 785-1112

1265 Highway 54 W
Fayetteville, GA 30214
Phone (770) 719-7000

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1159920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1645056000000",
    "number": "1659467314",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1405 CLIFTON RD NE FL 3",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303221060",
            "telephone_number": "404-785-6670",
            "fax_number": "404-785-1362"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1405 CLIFTON RD NE FL 3",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303221060",
            "telephone_number": "404-785-6670",
            "fax_number": "404-785-1362"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EDWARDS",
        "first_name": "BRENTAN",
        "middle_name": "M",
        "credential": "PAA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-04",
        "last_updated": "2022-02-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367H00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiologist Assistant",
            "state": "GA",
            "license": "4856",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "choa@choa.gadirect.net",
            "affiliation": "N",
            "address_1": "1405 Clifton Rd NE Fl 3",
            "city": "Atlanta",
            "state": "GA",
            "country_code": "US",
            "postal_code": "303221060",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Atlanta, GA

Sources for this page

Verify at the official NPI Registry.