Healthcare Provider Details

I. General information

NPI: 1699737445
Provider Name (Legal Business Name): GRADY HEALTH SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 JESSE HILL JR DRIVE HUGHES SPALDING CHILDREN'S HOSPITAL
ATLANTA GA
30303
US

IV. Provider business mailing address

5619 VININGS RETREAT PASS SW
MABLETON GA
30126-2569
US

V. Phone/Fax

Practice location:
  • Phone: 404-616-5650
  • Fax:
Mailing address:
  • Phone: 770-948-1834
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number140352
License Number StateGA

VIII. Authorized Official

Name: MRS. NAGHMA KHAN
Title or Position: DIRECTOR EMERGENCY SERVICES
Credential: M.D.
Phone: 404-785-6000