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DR. KEITH WILSON EDMONDS LPC
NPI 1073844395
Counselor - Professional in Evans, GA

Active since January 26, 2010PECOS EnrolledAccepts Medicare Assignment
1202 TOWN PARK LN STE 300, EVANS, GA 30809(706) 210-8855(706) 432-8775 Get Directions Write a Review

NPPES record last updated: May 12, 2026. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: May 12, 2026, Jan 8, 2026, Dec 24, 2025 and 2 more (5 updates tracked since 2021).

About Dr. Keith Wilson Edmonds Lpc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. KEITH WILSON EDMONDS LPC (NPI 1073844395) is an individual professional provider in Evans, Georgia, licensed in Georgia (LPC004579) and active in the NPI registry since January 2010. He is enrolled in Medicare PECOS and is a graduate of Other (2009).

NPPES Registry Identity

NPI1073844395
Entity TypeIndividualMale
Primary Taxonomy101YP2500X
Provider Legal NameDR. KEITH WILSON EDMONDSCredential: LPC
Location Address1202 TOWN PARK LN STE 300Evans, GA 30809-3477
Mailing Address4800 N Scottsdale Rd Ste 2500Scottsdale, AZ 85251-7630
Phone(706) 210-8855
Fax(706) 432-8775
Sole ProprietorYes
Medical School CMSOtherGraduated 2009
Enumeration DateJanuary 26, 2010
Last NPPES UpdateMay 12, 20265 updates tracked since enumeration
NPPES CertifiedMay 12, 2026
✔ NPI 1073844395 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCounselor · ProfessionalBehavioral Health & Social Service Providers
Taxonomy Code101YP2500X
License✔ Licensed in GA · LPC004579
1202 TOWN PARK LN STE 300, Evans, GA 30809
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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include UnitedHealthcare.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Dr. Keith Wilson Edmonds Lpc is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID1355750936
PECOS Enrollment IDI20240709001833
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Keith Edmonds reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Personal Recovery Network LLC
120 mi
Psychiatry
250 CORPORATE CENTER CT
Stockbridge, GA 30281
  • Reassigned Medicare billing, Georgia enrollment
  • 592 clinicians in this Medicare group
NPI 1881990869 (770) 389-8100

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Other Providers at the Same Location NPPES 19

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

CHARLES LAWSON BOST LPC
Marriage & Family Therapist
1202 TOWN PARK LN STE 300
EVANS, GA 30809
Columbia County (706) 210-8855
MS. JANESE ADELLIS BROWN LCSW
Social Worker (Clinical)
1202 TOWN PARK LN STE 300
EVANS, GA 30809
Columbia County (706) 210-8855
LESLIE JOHNSON OWEN LPC
Counselor (Professional)
1202 TOWN PARK LN STE 300
EVANS, GA 30809
Columbia County (706) 210-8855
KATHY DEXTER PA-C
Physician Assistant
1202 TOWN PARK LN STE 300
EVANS, GA 30809
Columbia County (706) 210-8855
SHAUNA LYNNE KENNEY LPC
Counselor (Professional)
1202 TOWN PARK LN STE 300
EVANS, GA 30809
Columbia County (706) 210-8855
ELLEN JESTER JENKINS LPC
Counselor (Professional)
1202 TOWN PARK LN STE 300
EVANS, GA 30809
Columbia County (706) 210-8855
AARON MEKHI MEANS ROSE LPC
Counselor (Professional)
1202 TOWN PARK LN STE 300
EVANS, GA 30809
Columbia County (706) 210-8855
MARY ALEXANDER ROSS APRN-NP
Nurse Practitioner (Psychiatric/Mental Health)
1202 TOWN PARK LN STE 300
EVANS, GA 30809
Columbia County (706) 210-8855

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Keith Edmonds's NPI number?

The NPI number for Keith Edmonds is 1073844395. It was assigned to this individual provider in the NPPES registry on January 26, 2010.

Where is Keith Edmonds located?

Keith Edmonds practices at 1202 Town Park Ln Ste 300, Evans, GA 30809. The listed phone number is (706) 210-8855.

What is Keith Edmonds's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Professional, with taxonomy code 101YP2500X.

Is Keith Edmonds enrolled in Medicare?

Yes. Keith Edmonds is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Which organization bills Medicare for Keith Edmonds's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Keith Edmonds reassigns Medicare benefits to Personal Recovery Network LLC (Stockbridge, GA). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Keith Edmonds's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Keith Edmonds accept?

Health plans from UnitedHealthcare list Keith Edmonds as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Keith Edmonds was last updated on May 12, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.