Provider Demographics
NPI:1285912600
Name:THE EMORY CLINIC INC
Entity type:Organization
Organization Name:THE EMORY CLINIC INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUNN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-778-5639
Mailing Address - Street 1:1365 CLIFTON RD NE
Mailing Address - Street 2:BUILDING A, 5TH FLOOR CLINIC ADMINISTRATION
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30322-1013
Mailing Address - Country:US
Mailing Address - Phone:404-778-5639
Mailing Address - Fax:
Practice Address - Street 1:1805 VERNON RD
Practice Address - Street 2:SUITE C, AMBULATORY SURGERY CENTER
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30240-3871
Practice Address - Country:US
Practice Address - Phone:706-812-9902
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-02
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA141136261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical