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General NPI Number Information
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NPI Number | 1164966164
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Entity Type | Organization
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Legal Business Name | GRADY EMS LLC
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Dates
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Enumeration Date | 12/09/2016
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Last Update Date | 02/20/2020
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Provider Practice Location Address
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Address Line | 745 MEMORIAL DR SE
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City | ATLANTA
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State | GA
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Zip | 30316-1185
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Country | US
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Telephone | 404-616-8880
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 936443
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City | ATLANTA
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State | GA
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Zip | 31193-0001
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Country | US
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Telephone | 401-616-7441
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Fax |
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Authorized Official
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Title or Position | REVENUE CYCLE ANALYST
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Name | KIMBERLY D MYERS
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Credential |
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Telephone | 404-616-7441
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number | 060-74
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License Number State | GA
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