Provider Demographics
NPI:1215258223
Name:MOOREHOUSE SCHOOL OF MEDICINE
Entity type:Organization
Organization Name:MOOREHOUSE SCHOOL OF MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT DIRECTOR OF GRADUATE MED
Authorized Official - Prefix:MRS
Authorized Official - First Name:COYEA
Authorized Official - Middle Name:ET
Authorized Official - Last Name:KIZZIE
Authorized Official - Suffix:
Authorized Official - Credentials:CM
Authorized Official - Phone:404-752-1857
Mailing Address - Street 1:1401 W PACES FERRY RD NW APT COMPLEX
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30327-2400
Mailing Address - Country:US
Mailing Address - Phone:412-889-8088
Mailing Address - Fax:
Practice Address - Street 1:720 WESTVIEW DR SW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30310-1458
Practice Address - Country:US
Practice Address - Phone:404-616-1426
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-14
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital