Provider Demographics
NPI:1316788003
Name:GRADY MEMORIAL HOSPITAL CORPORATION
Entity type:Organization
Organization Name:GRADY MEMORIAL HOSPITAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:MICHAUD
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:603-770-9206
Mailing Address - Street 1:2805 METROPOLITAN PKWY SW RM B131
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30315-7915
Mailing Address - Country:US
Mailing Address - Phone:404-616-1000
Mailing Address - Fax:
Practice Address - Street 1:2805 METROPOLITAN PKWY SW RM B131
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30315-7915
Practice Address - Country:US
Practice Address - Phone:404-616-0678
Practice Address - Fax:404-616-4306
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GRADY MEMORIAL HOSPITAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-06-05
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy