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General NPI Number Information
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NPI Number | 1992164495
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Entity Type | Organization
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Legal Business Name | EMORY HEALTHCARE
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Dates
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Enumeration Date | 02/12/2016
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Last Update Date | 03/14/2016
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Provider Practice Location Address
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Address Line | 791 WYLIE ST SE 102
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City | ATLANTA
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State | GA
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Zip | 30316-7200
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Country | US
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Telephone | 404-788-4396
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Fax |
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Provider Business Mailing Address
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Address Line | 791 WYLIE ST SE 102
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City | ATLANTA
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State | GA
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Zip | 30316-7200
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Country | US
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Telephone | 404-788-4396
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | GRETA RUSSLER
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Credential | FNP-BC
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Telephone | 404-788-4396
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QX0200X
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Taxonomy Name | Oncology Clinic/Center
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License Number | RN240539
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License Number State | GA
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