MEDICARE: GEORGIA INSTITUTE OF TECHNOLOGY STAMPS HEALTH SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QS1000X	Student Health Clinic/Center

General Provider Information

NPI Number	:	1043352016
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GEORGIA INSTITUTE OF TECHNOLOGY STAMPS HEALTH SERVICES

Provider Business Mailing Address
First Line	:	740 FERST DRIVE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30332-0470
Country	:	US
Telephone Number	:	404-894-2587
Fax Number	:	404-894-7480

Provider Business Practice Location Address
First Line	:	740 FERST DRIVE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30332-0470
Country	:	US
Telephone Number	:	404-894-2587
Fax Number	:	404-894-7480

Authorized Official
Title or Position	:	DIRECTOR, STAMPS HEALTH SERVICES
Name	:	DR. CINDY E SMITH
Credential	:	M.D.
Telephone Number	:	404-894-2587

Provider Enumeration Date	:	02/13/2007
Last Update Date	:	08/22/2020

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