Healthcare Provider Details

I. General information

NPI: 1992799050
Provider Name (Legal Business Name): GRADY MEMORIAL HOSPITAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2005
Last Update Date: 01/21/2025
Certification Date: 01/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 JESSE HILL JR DR, SE
ATLANTA GA
30303-3050
US

IV. Provider business mailing address

80 JESSE HILL JR DRIVE, SE BOX 26019
ATLANTA GA
30303-3050
US

V. Phone/Fax

Practice location:
  • Phone: 404-616-1000
  • Fax:
Mailing address:
  • Phone: 404-616-6695
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code283X00000X
TaxonomyRehabilitation Hospital
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number060-30
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number060069
License Number StateGA

VIII. Authorized Official

Name: MARK MEYER
Title or Position: CFO
Credential:
Phone: 404-616-2315