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General NPI Number Information
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NPI Number | 1508155276
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Entity Type | Organization
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Legal Business Name | THE MEADOWS EDGE, LLC
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Dates
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Enumeration Date | 04/04/2011
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Last Update Date | 06/13/2011
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Provider Practice Location Address
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Address Line | 110 W CRAWFORD ST SUITE 202
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City | DALTON
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State | GA
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Zip | 30720-4201
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Country | US
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Telephone | 706-913-1774
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Fax | 706-529-4199
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Provider Business Mailing Address
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Address Line | 110 W CRAWFORD ST SUITE 202
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City | DALTON
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State | GA
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Zip | 30720-4201
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Country | US
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Telephone | 706-913-1774
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Fax | 706-529-4199
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Authorized Official
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Title or Position | PRESIDENT
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Name | SHELLEY B HANKINS
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Credential | LPC
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Telephone | 706-913-1774
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | 4989
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License Number State | GA
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