Josephine T Ediale, MD is a
Pediatrics physician based in Villa Rica, Georgia. Josephine T Ediale is licensed to practice in Georgia (license number 050514) and her current practice location is 626 Dallas Hwy, Villa Rica, Georgia. She can be reached at her office (for appointments etc.) via phone at
(770) 459-9378.
NPI number for Josephine T Ediale is 1902880842 and her current mailing address is 4480 Blue Ridge Drive, Douglasville, Georgia. She
does not participate in medicare program and thus does not accept medicare assignments. Her NPI Number is 1902880842.
Physician's Profile
| Full Name | Josephine T Ediale |
|---|
| Gender | Female |
|---|
| Speciality | Pediatrics |
|---|
| Location | 626 Dallas Hwy, Villa Rica, Georgia |
|---|
| Accepts Medicare Assignments | Does not participate in Medicare Program. She may not accept medicare assignment. |
|---|
NPI Data:
- NPI Number: 1902880842
- Provider Enumeration Date: 12/05/2005
- Last Update Date: 10/07/2014
Medical Identifiers
Medical identifiers for Josephine T Ediale such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1902880842 | NPI | - | NPPES |
| 000922732C | Medicaid | GA | |
| 000922732 | Other | GA | PEACHSTATE |
| 01065140 | Other | GA | AMERIGROUP |
| 305728 | Other | GA | WELLCARE |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 208000000X | Pediatrics | 050514 (Georgia) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Josephine T Ediale is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Josephine T Ediale, MD
4480 Blue Ridge Drive,
Douglasville, GA 30135-1800
Ph: (770) 459-9378 | Josephine T Ediale, MD
626 Dallas Hwy,
Villa Rica, GA 30180-1209
Ph: (770) 459-9378 |
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