Provider Demographics
NPI:1316356066
Name:EMORY UNIVERSITY
Entity Type:Organization
Organization Name:EMORY UNIVERSITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RESIDENT DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAJAC-COX
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, NCS
Authorized Official - Phone:404-712-5660
Mailing Address - Street 1:3443 KINGSBORO RD NE
Mailing Address - Street 2:APARTMENT 1115
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30326-3316
Mailing Address - Country:US
Mailing Address - Phone:678-612-8264
Mailing Address - Fax:
Practice Address - Street 1:1462 CLIFTON RD NE
Practice Address - Street 2:SUITE 312
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322-1000
Practice Address - Country:US
Practice Address - Phone:404-712-5660
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-07
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT011587261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation