Provider Demographics
NPI:1124361092
Name:THE EMORY CLINIC, INC
Entity Type:Organization
Organization Name:THE EMORY CLINIC, INC
Other - Org Name:
Other - Org Type:
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:404-778-4870
Mailing Address - Street 1:1365 CLIFTON RD NE
Mailing Address - Street 2:4TH FLOOR, ROOM #4331
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30322-1013
Mailing Address - Country:US
Mailing Address - Phone:404-778-2010
Mailing Address - Fax:
Practice Address - Street 1:1365 CLIFTON RD NE
Practice Address - Street 2:4TH FLOOR, ROOM #4331
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322-1013
Practice Address - Country:US
Practice Address - Phone:404-778-2010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EMORY UNIVERSITY, EMORY HEALTHCARE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-03-29
Last Update Date:2013-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA0695020017Medicare NSC
GA47BBBJHMedicare PIN