MEDICARE: MOREHOUSE HEALTHCARE, INC.

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	390200000X	Student in an Organized Health Care Education/Training Program		GA

General Provider Information

NPI Number	:	1285137927
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOREHOUSE HEALTHCARE, INC.

Provider Business Mailing Address
First Line	:	1513 CLEVELAND AVE STE 500B
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30344-6949
Country	:	US
Telephone Number	:	404-756-1241
Fax Number	:	404-756-1237

Provider Business Practice Location Address
First Line	:	1513 CLEVELAND AVE STE 500B
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30344-6949
Country	:	US
Telephone Number	:	404-756-1241
Fax Number	:	404-756-1237

Authorized Official
Title or Position	:	DIRECTOR - EMPLOYEE HELATH SERVICES
Name	:	SARITA CATHCART
Credential	:
Telephone Number	:	404-756-1353

Provider Enumeration Date	:	03/08/2018
Last Update Date	:	03/28/2018

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