Provider Demographics
NPI:1023359627
Name:THE EMORY CLINIC INC.
Entity Type:Organization
Organization Name:THE EMORY CLINIC INC.
Other - Org Name:EMORY AESTHETIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
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:404-778-5014
Mailing Address - Street 1:101 W PONCE DE LEON AVE
Mailing Address - Street 2:DECATUR ANNEX
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-2542
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3200 DOWNWOOD CIR NW
Practice Address - Street 2:SUITE 640
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30327-1610
Practice Address - Country:US
Practice Address - Phone:404-351-0051
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE EMORY CLINIC INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-03-06
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical