MEDICARE: EMILY GRACE POINDEXTER MD

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	91720	GA
2	2080P0204X	Pediatric Emergency Medicine (Pediatrics) Physician	91720	GA
3	2080P0203X	Pediatric Critical Care Medicine Physician	39077	AL

General Provider Information

NPI Number	:	1639676638
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY GRACE POINDEXTER MD

Provider Business Mailing Address
First Line	:	1217 KENDRICK RD NE
Second Line	:
City	:	BROOKHAVEN
State	:	GA
Zip	:	30319-2819
Country	:	US
Telephone Number	:	317-366-9243
Fax Number	:	404-785-5846

Provider Business Practice Location Address
First Line	:	1001 JOHNSON FERRY RD
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30342-1605
Country	:	US
Telephone Number	:	404-785-2273
Fax Number	:	404-785-9168

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

Provider Enumeration Date	:	04/07/2018
Last Update Date	:	12/01/2025

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Directions to “ EMILY GRACE POINDEXTER MD” Practice Location

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