1679632137 NPI number — EHCA JOHNS CREEK, LLC

Table of content: (NPI 1679632137)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679632137 NPI number — EHCA JOHNS CREEK, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EHCA JOHNS CREEK, LLC
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 JOHNS CREEK HOSPITAL
Provider Other Organization Name Type Code:
3
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:
1679632137
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/15/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 277409
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30384-7409
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-454-2001
Provider Business Mailing Address Fax Number:
770-454-4279

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6325 HOSPITAL PARKWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JOHNS CREEK
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30097-5775
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-454-2000
Provider Business Practice Location Address Fax Number:
770-454-4279
Provider Enumeration Date:
12/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DAUNT-SAMFORD
Authorized Official First Name:
AVA
Authorized Official Middle Name:
E
Authorized Official Title or Position:
VP/CFO
Authorized Official Telephone Number:
404-686-4918

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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