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General NPI Number Information
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NPI Number | 1205872223
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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 | 06/20/2006
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Last Update Date | 09/03/2024
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Provider Practice Location Address
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Address Line | 1000 WHITE ST SW, STE 1004 ROOM 400
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City | ATLANTA
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State | GA
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Zip | 30310
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Country | US
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Telephone | 404-616-8618
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Fax | 404-616-6070
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Provider Business Mailing Address
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Address Line | PHARMACY ADMINISTRATION-26041 80 JESSE HILL JR DRIVE
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City | ATLANTA
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State | GA
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Zip | 30303
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Country | US
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Telephone | 404-616-3576
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Fax | 404-616-6070
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Authorized Official
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Title or Position | DIRECTOR OF PHARMACY
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Name | NICK MICHAUD
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Credential | RPH
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Telephone | 404-616-5500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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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 | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PHRE000512
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License Number State | GA
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