1073592747 NPI number — EMORY UNIVERSITY

Table of content: (NPI 1073592747)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073592747 NPI number — EMORY UNIVERSITY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EMORY UNIVERSITY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
EMORY GENETICS LABORATORY
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073592747
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/27/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2165 N DECATUR RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DECATUR
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30033-5307
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-778-8500
Provider Business Mailing Address Fax Number:
404-778-8559

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2165 N DECATUR RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DECATUR
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30033-5307
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-778-8500
Provider Business Practice Location Address Fax Number:
404-778-8559
Provider Enumeration Date:
01/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LAWLEY
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
Authorized Official Title or Position:
DEAN, MEDICAL SCHOOL/PROFESSOR
Authorized Official Telephone Number:
404-778-3681

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 104146 . This is a "PEACH STATE HEALTH PLAN" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 427837 . This is a "BC/BS" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 5293670 . This is a "AETNA PPO & CHOICE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 10044376 . This is a "AMERIGROUP" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 515449 . This is a "AETNA HMO" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 326448 . This is a "WELLCARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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