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General NPI Number Information
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NPI Number | 1598794729
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Entity Type | Organization
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Legal Business Name | THE EMORY CLINIC INC
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Dates
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Enumeration Date | 07/01/2006
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Last Update Date | 12/07/2007
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Provider Practice Location Address
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Address Line | 550 PEACHTREE ST
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City | ATLANTA
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State | GA
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Zip | 30308
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Country | US
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Telephone | 404-686-2410
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Fax |
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Provider Business Mailing Address
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Address Line | 1365 CLIFTON RD NE
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City | ATLANTA
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State | GA
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Zip | 30322-1013
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Country | US
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Telephone | 404-778-5639
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Fax | 404-778-0019
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Authorized Official
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Title or Position | OPERATIONS ADMINISTRATOR
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Name | MR. MIKE MASON
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Credential |
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Telephone | 404-778-5639
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number | 060277
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License Number State | GA
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