Healthcare Provider Details

I. General information

NPI: 1588663421
Provider Name (Legal Business Name): SAINT JOSEPH'S MERCY CARE SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2005
Last Update Date: 01/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3367 BUFORD HWY NE SUITE 910
ATLANTA GA
30329-1709
US

IV. Provider business mailing address

424 DECATUR ST SE
ATLANTA GA
30312-1848
US

V. Phone/Fax

Practice location:
  • Phone: 678-843-8700
  • Fax: 404-633-0502
Mailing address:
  • Phone: 678-843-8500
  • Fax: 678-843-8501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: MR. E THOMAS ANDREWS JR.
Title or Position: PRESIDENT
Credential:
Phone: 678-843-8502