Edgewood of Monticello

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

079020011 Issued in GA

Legal business name

EDGEWOOD OF MONTICELLO

Practice address

1178 College St
Monticello, GA 31064-2111

Phone

(706) 468-7100

Fax

(706) 468-7090

NPI assigned

Jun 19, 2012

Organization subpart

No

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

Authorized official

Name

Ms. Anna D. Marlow

Title

Administrator

Phone

(706) 468-7100

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1340064000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1340064000000",
    "number": "1992068670",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1178 COLLEGE ST",
            "city": "MONTICELLO",
            "state": "GA",
            "postal_code": "310642111",
            "telephone_number": "706-468-7100",
            "fax_number": "706-468-7090"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1178 COLLEGE ST",
            "city": "MONTICELLO",
            "state": "GA",
            "postal_code": "310642111",
            "telephone_number": "706-468-7100",
            "fax_number": "706-468-7090"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDGEWOOD OF MONTICELLO",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-06-19",
        "last_updated": "2012-06-19",
        "status": "A",
        "authorized_official_last_name": "MARLOW",
        "authorized_official_first_name": "ANNA",
        "authorized_official_middle_name": "D.",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "706-468-7100",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "GA",
            "license": "079020011",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Assisted Living Facility in Monticello, GA
• Providers in Monticello, GA by specialty
• Assisted Living Facility in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2012; 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.