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	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1447020268
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRADY MEMORIAL HOSPITAL CORPORATION

Provider Business Mailing Address
First Line	:	80 JESSE HILL JR DR SE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30303-3031
Country	:	US
Telephone Number	:	404-616-1000
Fax Number	:

Provider Business Practice Location Address
First Line	:	3896 PRINCETON LAKES WAY SW RM 126
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30331-5510
Country	:	US
Telephone Number	:	404-616-8630
Fax Number	:	404-616-6070

Authorized Official
Title or Position	:	EXEC DIRECTOR AMBULATORY PHARMACY
Name	:	MARY KATHERINE CHEELEY
Credential	:
Telephone Number	:	404-616-5711

Provider Enumeration Date	:	01/03/2024
Last Update Date	:	01/03/2024

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