Healthcare Provider Details

I. General information

NPI: 1962687996
Provider Name (Legal Business Name): EMORY UNIVERSITY STUDENT HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2008
Last Update Date: 01/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1525 CLIFTON RD NE SECOND FLOOR
ATLANTA GA
30322-4200
US

IV. Provider business mailing address

1525 CLIFTON RD NE SECOND FLOOR
ATLANTA GA
30322-4200
US

V. Phone/Fax

Practice location:
  • Phone: 404-727-7553
  • Fax:
Mailing address:
  • Phone: 404-727-7553
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1000X
TaxonomyStudent Health Clinic/Center
License Number044-049
License Number StateGA

VIII. Authorized Official

Name: MICHAEL HUEY VIII
Title or Position: EXECUTIVE DIRECTOR
Credential: M.D.
Phone: 404-712-8652