Provider Demographics
NPI:1073837167
Name:CRAWFORD LONG HOSPITAL
Entity Type:Organization
Organization Name:CRAWFORD LONG HOSPITAL
Other - Org Name:THE PHARMACY AT EMORY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HOSPITAL CFO
Authorized Official - Prefix:
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-686-2823
Mailing Address - Street 1:PO BOX 741066
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-1066
Mailing Address - Country:US
Mailing Address - Phone:404-778-2022
Mailing Address - Fax:404-778-2025
Practice Address - Street 1:1750 GAMBRELL DRIVE
Practice Address - Street 2:SUITE T203
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322
Practice Address - Country:US
Practice Address - Phone:404-778-2022
Practice Address - Fax:404-778-2025
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EMORY UNIVERSITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-03-18
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHRE009637333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA099009370AMedicaid
GA099009370AMedicaid