Healthcare Provider Details

I. General information

NPI: 1417983248
Provider Name (Legal Business Name): EDEL SANTOS ARNP, FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date: 01/21/2018
Reactivation Date: 01/26/2018

III. Provider practice location address

1631 GORDON HWY STE 17A
AUGUSTA GA
30906-2229
US

IV. Provider business mailing address

PO BOX 740015
ATLANTA GA
30374-0015
US

V. Phone/Fax

Practice location:
  • Phone: 706-230-7006
  • Fax: 762-257-7442
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9299615
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN-NP712687
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: