Provider Demographics
NPI:1699737445
Name:GRADY HEALTH SYSTEM
Entity type:Organization
Organization Name:GRADY HEALTH SYSTEM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR EMERGENCY SERVICES
Authorized Official - Prefix:MRS
Authorized Official - First Name:NAGHMA
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-785-6000
Mailing Address - Street 1:5619 VININGS RETREAT PASS SW
Mailing Address - Street 2:
Mailing Address - City:MABLETON
Mailing Address - State:GA
Mailing Address - Zip Code:30126-2569
Mailing Address - Country:US
Mailing Address - Phone:770-948-1834
Mailing Address - Fax:
Practice Address - Street 1:80 JESSE HILL JR DRIVE
Practice Address - Street 2:HUGHES SPALDING CHILDREN'S HOSPITAL
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30303
Practice Address - Country:US
Practice Address - Phone:404-616-5650
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA140352261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care