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General NPI Number Information
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NPI Number | 1114243813
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Entity Type | Organization
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Legal Business Name | GRADY MEMORIAL HOSPITAL CORPORATION
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Dates
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Enumeration Date | 04/20/2010
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Last Update Date | 01/21/2025
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Provider Practice Location Address
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Address Line | 80 JESSE HILL JR DR SE BOX 26019
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City | ATLANTA
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State | GA
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Zip | 30303-3031
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Country | US
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Telephone | 404-616-8880
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Fax | 404-616-9076
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Provider Business Mailing Address
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Address Line | PO BOX 935102
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City | ATLANTA
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State | GA
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Zip | 31193-5102
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Country | US
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Telephone | 404-616-5887
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Fax | 404-616-9076
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Authorized Official
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Title or Position | EXEC VP, GENERAL COUNSEL
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Name | TIMOTHY JEFFERSON
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Credential | ESQ
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Telephone | 404-616-6180
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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