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NPI Code Detail

MEDICARE: GRADY MEMORIAL HOSPITAL CORPORATION

MEDICARE: GRADY MEMORIAL HOSPITAL CORPORATION
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
1333600000XPharmacy
23336C0003XCommunity/Retail Pharmacy004658GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12131149OTHERPK
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1174538722
Entity Type Code : Organization
Provider Name (Legal Business Name) : GRADY MEMORIAL HOSPITAL CORPORATION
Provider Business Mailing Address
First Line : PHARMACY ADMINISTRATION-26041
Second Line : 80 JESSE HILL JR DRIVE
City : ATLANTA
State : GA
Zip : 30303
Country : US
Telephone Number : 404-616-3576
Fax Number : 404-616-6070
Provider Business Practice Location Address
First Line : 1595 CLEVELAND AVE
Second Line :
City : EAST POINT
State : GA
Zip : 30344-3200
Country : US
Telephone Number : 404-616-9231
Fax Number : 404-768-6455
Authorized Official
Title or Position : DIRECTOR OF PHARMACY ADMINISTRATION
Name : VAL HALLMAN
Credential :
Telephone Number : 404-616-3576
Provider Enumeration Date : 07/30/2006
Last Update Date : 02/10/2016

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Directions to “GRADY MEMORIAL HOSPITAL CORPORATION ” Practice Location

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