Healthcare Provider Details

I. General information

NPI: 1386165504
Provider Name (Legal Business Name): THE EMORY CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2017
Last Update Date: 03/14/2022
Certification Date: 03/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7813 SPIVEY STATION BLVD
JONESBORO GA
30236-2900
US

IV. Provider business mailing address

2201 HENDERSON MILL RD NE STE 160
ATLANTA GA
30345-2711
US

V. Phone/Fax

Practice location:
  • Phone: 404-778-3184
  • Fax:
Mailing address:
  • Phone: 404-778-5079
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. BROOKE MOORE
Title or Position: CFO
Credential:
Phone: 404-778-5014