Healthcare Provider Details

I. General information

NPI: 1508066598
Provider Name (Legal Business Name): EMORY HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2007
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1364 CLIFTON RD NE HOSPITAL MEDICINE BOX M7
ATLANTA GA
30322-1064
US

IV. Provider business mailing address

1364 CLIFTON RD NE HOSPITAL MEDICINE BOX M7
ATLANTA GA
30322-1059
US

V. Phone/Fax

Practice location:
  • Phone: 404-778-3914
  • Fax: 404-778-5495
Mailing address:
  • Phone: 404-778-3914
  • Fax: 404-778-5495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number59808
License Number StateGA

VIII. Authorized Official

Name: DR. QURAT-UL-AIN KIZILBASH
Title or Position: HOSPITALIST
Credential: M.D.
Phone: 404-686-7869