Healthcare Provider Details

I. General information

NPI: 1891907184
Provider Name (Legal Business Name): EMORY UNIVERSITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1364 CLIFTON RD NE DEPT OF ANESTHESIOLOGY, EUH 3RD FLOOR
ATLANTA GA
30322-1059
US

IV. Provider business mailing address

821 RALPH MCGILL BLVD NE UNIT #3404
ATLANTA GA
30306-4364
US

V. Phone/Fax

Practice location:
  • Phone: 404-778-3903
  • Fax:
Mailing address:
  • Phone: 404-931-1280
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number059033
License Number StateGA

VIII. Authorized Official

Name: DR. ANNETTE D VIZENA
Title or Position: RESIDENT
Credential: M.D.
Phone: 404-778-3903