Healthcare Provider Details

I. General information

NPI: 1801834908
Provider Name (Legal Business Name): EMORY HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1365 CLIFTON RD NE
ATLANTA GA
30322-1013
US

IV. Provider business mailing address

1365 CLIFTON RD NE
ATLANTA GA
30322-1013
US

V. Phone/Fax

Practice location:
  • Phone: 404-778-4367
  • Fax: 404-778-4655
Mailing address:
  • Phone: 404-778-4367
  • Fax: 404-778-4655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1998
License Number StateGA

VIII. Authorized Official

Name: DR. CHARLES NEMEROFF
Title or Position: CHAIR, DEPARTMENT OF PSYCHIATRY
Credential: M.D.
Phone: 404-727-8382