NICHOLAS EDWARDS (PT, DPT) – Physical Therapist, NPI 1124806534

NICHOLAS EDWARDS (PT, DPT) is a healthcare provider. based in Loganville, Georgia. specializing in PHYSICAL THERAPIST IN PRIVATE PRACTICE. They hold the professional credentials PT, DPT. They hold a License No. PT016876 (GA). The NPI Number for NICHOLAS EDWARDS (PT, DPT) is 1124806534

Main info

Male
3 Years Of Experience
Accepts Medicare Assignment
Name
NICHOLAS EDWARDS (PT, DPT)
NPI
1124806534
Phone
(770) 466-9343
Address
4743 ATLANTA HWY STE 100
Enumeration Date
18 September 2023
Last Update Date
18 September 2023

Doctor Profile

Medical School Name
PHILADELPHIA COLLEGE OF OSTEOPATHIC MEDICINE
Secondary Phone
7704669343
Graduation Year
2023 (3 years ago)
PAC ID
1355792003
Group Practice PAC ID
5890692917
Professional Enrollment ID
I20240108003915
Address ID
GA300522686LO4743XHWYX301
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience28
Completeness75
Years active:2State licenses:1Digital endpointsOther names

2,870 PHYSICAL THERAPIST IN PRIVATE PRACTICE in GA

Provider Addresses for NICHOLAS EDWARDS (PT, DPT)

  • 4743 ATLANTA HWY STE 100

    LOGANVILLE, GA 300522686

    Phone: (770) 466-9343

    Fax: (770) 466-9345

    Type: Location

  • 2400 WISTERIA DR STE A

    SNELLVILLE, GA 300782689

    Phone: (770) 982-0102

    Fax: (770) 982-0130

    Type: Mailing

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2024-01-08

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20240108003915IPhysical Therapist In Private PracticeGATBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 30052)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 5890692917View full group profile
NameSpecialtyState
Physical Therapist In Private PracticeGA
Physical Therapist In Private PracticeGA
Physical Therapist In Private PracticeTN
Physical Therapist In Private PracticeGA
Physical Therapist In Private PracticeTN
Physical Therapist In Private PracticeGA
Physical Therapist In Private PracticeGA
Physical Therapist In Private PracticeTN
-GA
-GA

Reviews

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Frequently asked questions

What federal number belongs to NICHOLAS EDWARDS (PT, DPT)?
The federal identifier for NICHOLAS EDWARDS (PT, DPT) is NPI 1124806534.
Is NICHOLAS EDWARDS (PT, DPT)'s enrollment marked active?
An active flag here means the NPI record is not in a deactivated state.
What field does NICHOLAS EDWARDS (PT, DPT) work in?
You can think of NICHOLAS EDWARDS (PT, DPT) as practicing within Physical Therapist. Clinical services aligned with this taxonomy classification.
Does NICHOLAS EDWARDS (PT, DPT) practice in Georgia?
You will see Loganville, Georgia on file for NICHOLAS EDWARDS (PT, DPT) alongside any extra practice locations.
What if Loganville, Georgia seems incomplete?
Street-level detail can be omitted — open the full address list for this NPI.

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