Provider Demographics
NPI:1992164495
Name:EMORY HEALTHCARE
Entity type:Organization
Organization Name:EMORY HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:GRETA
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSSLER
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BC
Authorized Official - Phone:404-788-4396
Mailing Address - Street 1:791 WYLIE ST SE
Mailing Address - Street 2:102
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30316-7200
Mailing Address - Country:US
Mailing Address - Phone:404-788-4396
Mailing Address - Fax:
Practice Address - Street 1:791 WYLIE ST SE
Practice Address - Street 2:102
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30316-7200
Practice Address - Country:US
Practice Address - Phone:404-788-4396
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-12
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN240539261QX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0200XAmbulatory Health Care FacilitiesClinic/CenterOncology