1396025367 NPI number — GRADY MEMORIAL HOSPITAL CORPORATION

Table of content: (NPI 1396025367)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396025367 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:
1396025367
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/21/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 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:
30303-0001
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:
80 GILMER ST ROOM G300
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30303
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-616-3190
Provider Business Practice Location Address Fax Number:
404-616-6070
Provider Enumeration Date:
08/23/2011

Additional Information

Authorized Official

Authorized Official Last Name:
HALLMAN
Authorized Official First Name:
VALAURA
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR PHARMACY ADMINISTRATI
Authorized Official Telephone Number:
404-616-3576

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2132235 . This is a "PK" identifier . This identifiers is of the category "OTHER".




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