Healthcare Provider Details

I. General information

NPI: 1215444252
Provider Name (Legal Business Name): ARTHUR M. BLANK HOSPITAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2017
Last Update Date: 01/16/2025
Certification Date: 01/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2220 N DRUID HILLS RD NE
ATLANTA GA
30329-3117
US

IV. Provider business mailing address

1575 NE EXPRESSWAY
ATLANTA GA
30329-2401
US

V. Phone/Fax

Practice location:
  • Phone: 404-785-5252
  • Fax:
Mailing address:
  • Phone: 404-785-7928
  • Fax: 404-785-7932

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License NumberPHRE005903
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPHRE005903
License Number StateGA

VIII. Authorized Official

Name: MANAGED CARE
Title or Position: MANAGER, PROVIDER ENROLLMENT
Credential:
Phone: 404-785-7876