| Edgecare 360 Llc | |
|
2470 Windy Hill Rd Se Ste 300 Marietta GA 30067-8621 | |
| (770) 933-5328 | |
| Not Available |
| Full Name | Edgecare 360 Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 2470 Windy Hill Rd Se Ste 300, Marietta, Georgia |
| Authorized Official Name and Position | Jennifer Edge (CEO/OWNER) |
| Authorized Official Contact | 9102122496 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Edgecare 360 Llc 225 Franklin Farms Cir Fayetteville GA 30214-3363 Ph: (678) 561-5066 | Edgecare 360 Llc 2470 Windy Hill Rd Se Ste 300 Marietta GA 30067-8621 Ph: (770) 933-5328 |
| NPI Number | 1306590328 |
|---|---|
| Provider Enumeration Date | 02/08/2022 |
| Last Update Date | 12/04/2023 |
| Certification Date | 12/04/2023 |
| Medicare PECOS PAC ID | 1658758396 |
|---|---|
| Medicare Enrollment ID | O20220518000876 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306590328 | NPI | - | NPPES |
| Provider Name | Jennifer A Edge |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1467920975 PECOS PAC ID: 6103232152 Enrollment ID: I20210317000785 |
| Provider Name | Regina W Holley |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1356037915 PECOS PAC ID: 4981040847 Enrollment ID: I20240313003697 |
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