Healthcare Provider Details

I. General information

NPI: 1093128860
Provider Name (Legal Business Name): EDELWEISS VON MAACK NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EDELWEISS WHITSON NP-C

II. Dates (important events)

Enumeration Date: 06/09/2014
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

197 CURTIS PKWY NE
CALHOUN GA
30701-2063
US

IV. Provider business mailing address

197 CURTIS PKWY NE
CALHOUN GA
30701-2063
US

V. Phone/Fax

Practice location:
  • Phone: 706-602-9546
  • Fax: 877-734-1330
Mailing address:
  • Phone: 706-602-9546
  • Fax: 877-734-1330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number95008619
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberGAA-NP004959
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number18217
License Number StateTN
# 4
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAP60451797
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: