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
1	314000000X	Skilled Nursing Facility	1-060-1275	GA

Other Identifiers

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

General Provider Information

NPI Number	:	1437255395
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRADY MEMORIAL HOSPITAL CORPORATION

Provider Business Mailing Address
First Line	:	2800 SPRINGDALE RD SW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30315-7802
Country	:	US
Telephone Number	:	404-616-8100
Fax Number	:

Provider Business Practice Location Address
First Line	:	2800 SPRINGDALE RD SW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30315-7802
Country	:	US
Telephone Number	:	404-616-8100
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MISS CORA LEDARE BULLOCK
Credential	:
Telephone Number	:	404-616-8110

Provider Enumeration Date	:	09/16/2006
Last Update Date	:	01/21/2025

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