MEDICARE: GEORGIA INSTITUTE OF TECHNOLOGY

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	PHRE005743	GA

General Provider Information

NPI Number	:	1396873527
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GEORGIA INSTITUTE OF TECHNOLOGY

Provider Business Mailing Address
First Line	:	740 FERST DRIVE, NW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30332-0470
Country	:	US
Telephone Number	:	404-894-7294
Fax Number	:	404-894-4142

Provider Business Practice Location Address
First Line	:	740 FERST DRIVE, NW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30332-0470
Country	:	US
Telephone Number	:	404-894-1430
Fax Number	:	404-894-4142

Authorized Official
Title or Position	:	SENIOR DIRECTOR
Name	:	GREGORY MOORE
Credential	:	M.D.
Telephone Number	:	404-895-3256

Provider Enumeration Date	:	03/01/2007
Last Update Date	:	07/15/2014

Similar Medicare Providers

1497737993 — DR. GREGORY ROBERT MOORE MD
Practice Location Address:

STAMPS HEALTH SERVICES , 740 FERST DR NW
ATLANTA, GA
30332-0470

Practice Phone: 404-894-2587
Practice Fax: 404-385-3257

1043352016 — GEORGIA INSTITUTE OF TECHNOLOGY STAMPS HEALTH SERVICES
Practice Location Address:

740 FERST DRIVE
ATLANTA, GA
30332-0470

Practice Phone: 404-894-2587
Practice Fax: 404-894-7480

1851514541 — DR. KATRINA SCHULER MITCHELL DDS
Practice Location Address:

740 FERST DR
ATLANTA, GA
30332-0470

Practice Phone: 404-385-5148
Practice Fax: 404-385-5151

1922299056 — DR. WILLIAM JOSEPH MANNS MD
Practice Location Address:

740 FERST DRIVENW , HEALTH SERVICE GEORGIA TECH
ATLANTA, GA
30332-0470

Practice Phone: 404-894-1423
Practice Fax: 404-385-0717

1649462896 — KATHY STUKES ALLAN MD
Practice Location Address:

740 FERST DRIVE
ATLANTA, GA
30332-0470

Practice Phone: 404-894-1429
Practice Fax: 404-385-0717

1609068865 — DIANE LINDA HEATH MD
Practice Location Address:

740 FERST DR
ATLANTA, GA
30332-0470

Practice Phone: 404-894-1428
Practice Fax: 404-385-0717

Directions to “GEORGIA INSTITUTE OF TECHNOLOGY ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.