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General NPI Number Information
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NPI Number | 1487199972
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Entity Type | Organization
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Legal Business Name | SAINT JOSEPH'S MERCY CARE SERVICES, INC.
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Dates
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Enumeration Date | 12/20/2016
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Last Update Date | 10/01/2025
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Provider Practice Location Address
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Address Line | 424 DECATUR STREET NE SUITE 100
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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 | 404-439-0949
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Fax | 614-652-0785
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Provider Business Mailing Address
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Address Line | 424 DECATUR ST SE
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City | ATLANTA
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State | GA
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Zip | 30312-1848
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Country | US
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Telephone | 678-843-8654
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Fax | 404-588-9834
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Authorized Official
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Title or Position | CHIEF OF CARE DELIVERY
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Name | MS. PEARLY ITTICKATHRA
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Credential |
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Telephone | 678-843-8654
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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 | PHRE010329
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License Number State | GA
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