Healthcare Provider Details

I. General information

NPI: 1629589916
Provider Name (Legal Business Name): EDITH ARTERBERRY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2017
Last Update Date: 09/05/2025
Certification Date: 09/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3755 MAIN ST UNIT 101
COLLEGE PARK GA
30337-3543
US

IV. Provider business mailing address

1267 PEBBLEBROOK RD SE
MABLETON GA
30126-5615
US

V. Phone/Fax

Practice location:
  • Phone: 770-846-2228
  • Fax:
Mailing address:
  • Phone: 770-846-2228
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN220258
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN220258
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: