Provider Demographics
NPI:1124598362
Name:GRADY MEMORIAL HOSPITAL CORPORATION
Entity Type:Organization
Organization Name:GRADY MEMORIAL HOSPITAL CORPORATION
Other - Org Name:CORRELL CANCER CENTER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR OF AMB PHARMACY
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY KATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHEELEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:404-616-5711
Mailing Address - Street 1:80 JESSE HILL JR DR SE
Mailing Address - Street 2:PHARMACY ADMINISTRATION, BOX 26041
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30303
Mailing Address - Country:US
Mailing Address - Phone:404-616-3415
Mailing Address - Fax:404-616-6070
Practice Address - Street 1:80 GILMER STREET
Practice Address - Street 2:ROOM 8570
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30303
Practice Address - Country:US
Practice Address - Phone:404-489-9144
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-30
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy