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General NPI Number Information
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NPI Number | 1275432858
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Entity Type | Organization
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Legal Business Name | EDGEWATER MEDICAL LLC
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Dates
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Enumeration Date | 11/02/2026
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Last Update Date | 11/02/2026
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Provider Practice Location Address
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Address Line | 465 LEASINGHAM WAY
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City | JOHNS CREEK
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State | GA
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Zip | 30097-7198
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Country | US
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Telephone | 770-318-8565
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Fax |
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Provider Business Mailing Address
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Address Line | 465 LEASINGHAM WAY APT 131
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City | JOHNS CREEK
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State | GA
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Zip | 30097-7198
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Country | US
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Telephone | 770-318-8565
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Fax |
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Authorized Official
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Title or Position | PMHNP-BC
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Name | ONYINYECHI ULOMA EKE
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Credential | EKE
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Telephone | 770-318-8565
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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