Provider Demographics
NPI:1306472063
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:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:BROOKE
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-778-5014
Mailing Address - Street 1:101 W PONCE DE LEON AVE
Mailing Address - Street 2:DECATUR PLAZA ANNEX- ATTN: JWILLIAMS
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-2542
Mailing Address - Country:US
Mailing Address - Phone:404-778-5079
Mailing Address - Fax:
Practice Address - Street 1:2665 N DECATUR RD STE 740
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-6148
Practice Address - Country:US
Practice Address - Phone:404-544-1405
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EMORY CLINIC INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-03-13
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical