Healthcare Provider Details

I. General information

NPI: 1285912600
Provider Name (Legal Business Name): THE EMORY CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2011
Last Update Date: 03/14/2022
Certification Date: 03/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1805 VERNON RD SUITE C, AMBULATORY SURGERY CENTER
LAGRANGE GA
30240-3871
US

IV. Provider business mailing address

1365 CLIFTON RD NE BUILDING A, 5TH FLOOR CLINIC ADMINISTRATION
ATLANTA GA
30322-1013
US

V. Phone/Fax

Practice location:
  • Phone: 706-812-9902
  • Fax:
Mailing address:
  • Phone: 404-778-5639
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number141136
License Number StateGA

VIII. Authorized Official

Name: MR. DONALD BRUNN
Title or Position: COO
Credential:
Phone: 404-778-5639