Healthcare Provider Details

I. General information

NPI: 1770499683
Provider Name (Legal Business Name): EDQUITY AT THE MARGINS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3112 LAURA STREET
GALLATIN TN
37066-6764
US

IV. Provider business mailing address

3112 LAURA STREET
GALLATIN TN
37066-6764
US

V. Phone/Fax

Practice location:
  • Phone: 305-331-3976
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. REBA CLARKE
Title or Position: EXECUTIVE DIRECTOR
Credential: ED.D.
Phone: 305-331-3976