Healthcare Provider Details

I. General information

NPI: 1730556275
Provider Name (Legal Business Name): MOREHOUSE HEALTHCARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2015
Last Update Date: 03/10/2021
Certification Date: 03/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 HOWELL MILL RD NW SUITE 550
ATLANTA GA
30318-2538
US

IV. Provider business mailing address

720 WESTVIEW DR SW STE 100
ATLANTA GA
30310-1458
US

V. Phone/Fax

Practice location:
  • Phone: 404-756-1400
  • Fax: 404-756-1402
Mailing address:
  • Phone: 404-756-5752
  • Fax: 404-756-5274

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JASMINE S BAJNATH
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 404-756-5752