Healthcare Provider Details

I. General information

NPI: 1023359627
Provider Name (Legal Business Name): THE EMORY CLINIC INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2013
Last Update Date: 03/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 DOWNWOOD CIR NW SUITE 640
ATLANTA GA
30327-1610
US

IV. Provider business mailing address

101 W PONCE DE LEON AVE DECATUR ANNEX
DECATUR GA
30030-2542
US

V. Phone/Fax

Practice location:
  • Phone: 404-351-0051
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. DONALD BRUNN
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 404-778-5014