MEDICARE: GEORGIA ELECTRO DIAGNOSTIC PROVIDERS P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA1903X	Ambulatory Surgical Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538306709
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GEORGIA ELECTRO DIAGNOSTIC PROVIDERS P.C.

Provider Business Mailing Address
First Line	:	2550 WINDY HILL RD
Second Line	:	SUITE 215
City	:	MARIETTA
State	:	GA
Zip	:	30067-8654
Country	:	US
Telephone Number	:	770-850-8464
Fax Number	:	770-850-9727

Provider Business Practice Location Address
First Line	:	2550 WINDY HILL RD
Second Line	:	SUITE 215
City	:	MARIETTA
State	:	GA
Zip	:	30067-8654
Country	:	US
Telephone Number	:	770-850-8464
Fax Number	:	770-850-9727

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	DR. ROBERT E. WINDSOR
Credential	:	MD
Telephone Number	:	770-850-8464

Provider Enumeration Date	:	01/09/2009
Last Update Date	:	01/09/2009

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