Healthcare Provider Details

I. General information

NPI: 1407544216
Provider Name (Legal Business Name): ANYTIME MD INTERNAL MEDICINE & PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2023
Last Update Date: 10/16/2025
Certification Date: 10/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4898 AUSTELL RD STE B
AUSTELL GA
30106-2055
US

IV. Provider business mailing address

4898 AUSTELL RD STE B
AUSTELL GA
30106-2055
US

V. Phone/Fax

Practice location:
  • Phone: 770-675-6149
  • Fax: 770-635-8017
Mailing address:
  • Phone: 770-675-6149
  • Fax: 770-635-8017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: PAUL EDJUA
Title or Position: OWNER/MEDICAL DIRECTOR
Credential: MD
Phone: 530-848-5863