MEDICARE: JOSEPHINE T EDIALE M.D.

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	208000000X	Pediatrics Physician	050514	GA

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
2	000922732	OTHER	GA	PEACHSTATE
3	01065140	OTHER	GA	AMERIGROUP
4	305728	OTHER	GA	WELLCARE

General Provider Information

NPI Number	:	1902880842
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPHINE T EDIALE M.D.

Provider Business Mailing Address
First Line	:	4480 BLUE RIDGE DRIVE
Second Line	:
City	:	DOUGLASVILLE
State	:	GA
Zip	:	30135-1800
Country	:	US
Telephone Number	:	770-459-9378
Fax Number	:	770-459-8613

Provider Business Practice Location Address
First Line	:	626 DALLAS HWY
Second Line	:
City	:	VILLA RICA
State	:	GA
Zip	:	30180-1209
Country	:	US
Telephone Number	:	770-459-9378
Fax Number	:	770-459-8613

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/05/2005
Last Update Date	:	10/07/2014

Similar Medicare Providers

1730194457 — TMC INTERNAL MEDICINE ASSOCIATES VILLA RICA
Practice Location Address:

690 DALLAS HWY , SUITE 303
VILLA RICA, GA
30180-1209

Practice Phone: 770-456-3790
Practice Fax: 770-456-3785

1902811748 — TMC GASTROENTEROLOGY ASSOCIATES INC
Practice Location Address:

690 DALLAS HWY , SUITE 304
VILLA RICA, GA
30180-1209

Practice Phone: 770-456-3786
Practice Fax: 770-456-3806

1053422840 — MARTHA HAACK
Practice Location Address:

690 DALLAS HWY , SUITE 104
VILLA RICA, GA
30180-1209

Practice Phone: 404-778-8440
Practice Fax:

1568563914 — EUGENE STANLEY HURWITZ MD
Practice Location Address:

690 DALLAS HWY , SUITE 101
VILLA RICA, GA
30180-1209

Practice Phone: 770-459-0620
Practice Fax: 770-836-4954

1487742532 — WESTCARE VILLA RICA PEDIATRICS
Practice Location Address:

626 DALLAS HWY
VILLA RICA, GA
30180-1209

Practice Phone: 770-459-9378
Practice Fax: 770-459-8613

1437830775 — AHTYANNA KENDRICK CPNP-PC
Practice Location Address:

626 DALLAS HWY
VILLA RICA, GA
30180-1209

Practice Phone: 770-459-9378
Practice Fax:

Directions to “ JOSEPHINE T EDIALE M.D.” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.