1174538722 NPI number — GRADY MEMORIAL HOSPITAL CORPORATION

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174538722 NPI number — GRADY MEMORIAL HOSPITAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GRADY MEMORIAL HOSPITAL CORPORATION
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:
Provider Other Organization Name Type Code:
6
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:
1174538722
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/10/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PHARMACY ADMINISTRATION-26041
Provider Second Line Business Mailing Address:
80 JESSE HILL JR DRIVE
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30303
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-616-3576
Provider Business Mailing Address Fax Number:
404-616-6070

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1595 CLEVELAND AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EAST POINT
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30344-3200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-616-9231
Provider Business Practice Location Address Fax Number:
404-768-6455
Provider Enumeration Date:
07/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HALLMAN
Authorized Official First Name:
VAL
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF PHARMACY ADMINISTRATION
Authorized Official Telephone Number:
404-616-3576

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 004658 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2131149 . This is a "PK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 937307I , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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