Healthcare Provider Details

I. General information

NPI: 1891516753
Provider Name (Legal Business Name): THE EMORY CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2024
Last Update Date: 10/22/2024
Certification Date: 10/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 EXECUTIVE PARK SOUTH NE STE 160
ATLANTA GA
30329-2248
US

IV. Provider business mailing address

2201 HENDERSON MILL RD NE STE 160
ATLANTA GA
30345-2711
US

V. Phone/Fax

Practice location:
  • Phone: 404-712-6929
  • Fax:
Mailing address:
  • Phone: 404-778-5079
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: ADAM TRIBBETT
Title or Position: VP, EHC MKT SRVC & EHN EHI MED
Credential:
Phone: 404-778-5294