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General NPI Number Information
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NPI Number | 1508134156
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Entity Type | Organization
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Legal Business Name | EDUCATION SYSTEM MANAGEMENT, INC
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Dates
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Enumeration Date | 12/12/2011
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Last Update Date | 01/06/2022
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Provider Practice Location Address
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Address Line | 125 HIGHWAY 138
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City | RIVERDALE
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State | GA
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Zip | 30274
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Country | US
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Telephone | 770-742-0265
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Fax | 770-742-0862
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Provider Business Mailing Address
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Address Line | 1115 MOUNT ZION RD SUITE C
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City | MORROW
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State | GA
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Zip | 30260-2266
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Country | US
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Telephone | 770-742-0265
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Fax | 770-742-0862
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Authorized Official
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Title or Position | CEO
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Name | DR. CARROLL BRADDY
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Credential | M.D.,MBA
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Telephone | 770-892-5284
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CSW003727
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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