Healthcare Provider Details

I. General information

NPI: 1578834008
Provider Name (Legal Business Name): EMORY HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2012
Last Update Date: 01/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1365 CLIFTON RD NE
ATLANTA GA
30322-1013
US

IV. Provider business mailing address

1365 CLIFTON RD NE
ATLANTA GA
30322-1013
US

V. Phone/Fax

Practice location:
  • Phone: 404-686-5500
  • Fax: 404-778-4431
Mailing address:
  • Phone: 404-686-5500
  • Fax: 404-778-4431

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License NumberRN177619
License Number StateGA

VIII. Authorized Official

Name: MS. CICELY A ROSS
Title or Position: TECHNICAL DIRECTOR, INTERNAL MEDICI
Credential: RRT/BSN, P-S
Phone: 404-219-4122