Provider Demographics
NPI:1396025367
Name:GRADY MEMORIAL HOSPITAL CORPORATION
Entity Type:Organization
Organization Name:GRADY MEMORIAL HOSPITAL CORPORATION
Other - Org Name:GRADY CORRELL RETAIL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR PHARMACY ADMINISTRATI
Authorized Official - Prefix:
Authorized Official - First Name:VALAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:HALLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-616-3576
Mailing Address - Street 1:PO BOX 26041
Mailing Address - Street 2:80 JESSE HILL JR DRIVE
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30303-0001
Mailing Address - Country:US
Mailing Address - Phone:404-616-3576
Mailing Address - Fax:404-616-6070
Practice Address - Street 1:80 GILMER ST ROOM G300
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30303
Practice Address - Country:US
Practice Address - Phone:404-616-3190
Practice Address - Fax:404-616-6070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-23
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0003X
GAPHRE0097733336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2132235OtherPK