MEDICARE: MOREHOUSE HEALTHCARE, INC.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	207QA0000X	Adolescent Medicine (Family Medicine) Physician
2	207QA0505X	Adult Medicine Physician
3	207QG0300X	Geriatric Medicine (Family Medicine) Physician
4	207QH0002X	Hospice and Palliative Medicine (Family Medicine) Physician
5	207R00000X	Internal Medicine Physician
6	207V00000X	Obstetrics & Gynecology Physician
7	207VG0400X	Gynecology Physician
8	207VX0000X	Obstetrics Physician
9	207QS0010X	Sports Medicine (Family Medicine) Physician
10	2080P0207X	Pediatric Hematology & Oncology Physician
11	208600000X	Surgery Physician
12	208000000X	Pediatrics Physician
13	103T00000X	Psychologist
14	103TF0000X	Family Psychologist
15	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1285813212
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOREHOUSE HEALTHCARE, INC.

Provider Business Mailing Address
First Line	:	720 WESTVIEW DR SW STE 100
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30310-1458
Country	:	US
Telephone Number	:	404-756-5752
Fax Number	:	404-756-5274

Provider Business Practice Location Address
First Line	:	455 LEE ST SW STE 300
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30310-1408
Country	:	US
Telephone Number	:	404-756-1241
Fax Number	:	404-756-1237

Authorized Official
Title or Position	:	CREDENTIALING MANAGER
Name	:	JASMINE BAJNATH
Credential	:
Telephone Number	:	404-756-5752

Provider Enumeration Date	:	10/26/2007
Last Update Date	:	06/14/2023

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