MEDICARE: EMORY SPECIALTY ASSOCIATES, LLC

Medicare Provider Information

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

#	Taxonomy Code	Taxonomy
1	207LP2900X	Pain Medicine (Anesthesiology) Physician
2	207P00000X	Emergency Medicine Physician
3	207ZB0001X	Blood Banking & Transfusion Medicine Physician
4	207ZC0500X	Cytopathology Physician
5	207ZF0201X	Forensic Pathology Physician
6	207ZH0000X	Hematology (Pathology) Physician
7	207ZI0100X	Immunopathology Physician
8	207ZM0300X	Medical Microbiology Physician
9	207ZP0101X	Anatomic Pathology Physician
10	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician
11	207ZP0104X	Chemical Pathology Physician
12	207ZP0105X	Clinical Pathology/Laboratory Medicine Physician
13	207Q00000X	Family Medicine Physician
14	207R00000X	Internal Medicine Physician
15	207L00000X	Anesthesiology Physician

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

NPI Number	:	1407864168
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMORY SPECIALTY ASSOCIATES, LLC

Provider Business Mailing Address
First Line	:	101 W PONCE DE LEON AVE
Second Line	:	RM 325
City	:	DECATUR
State	:	GA
Zip	:	30030-2542
Country	:	US
Telephone Number	:	404-778-5014
Fax Number	:

Provider Business Practice Location Address
First Line	:	303 SMITH ST
Second Line	:
City	:	LAGRANGE
State	:	GA
Zip	:	30240-2745
Country	:	US
Telephone Number	:	404-778-4888
Fax Number	:

Authorized Official
Title or Position	:	COO
Name	:	MR. DONALD BRUNN
Credential	:
Telephone Number	:	404-778-4870

Provider Enumeration Date	:	08/04/2006
Last Update Date	:	04/23/2010

303 SMITH ST
LAGRANGE, GA
30240-2745

Practice Phone: 706-812-4238
Practice Fax:

303 SMITH ST
LAGRANGE, GA
30240-2745

Practice Phone: 706-812-4391
Practice Fax: 706-812-4032

303 SMITH ST
LAGRANGE, GA
30240-2745