Provider Demographics
NPI:1467486373
Name:THE EMORY CLINIC, INC
Entity Type:Organization
Organization Name:THE EMORY CLINIC, INC
Other - Org Name:EMORY SPINE PHYSIATRY OUTPATIENT CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:OPERATIONS ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:MASON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-778-5639
Mailing Address - Street 1:1365 CLIFTON RD NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30322-1013
Mailing Address - Country:US
Mailing Address - Phone:404-778-5639
Mailing Address - Fax:404-778-0019
Practice Address - Street 1:59 EXECUTIVE PARK DR
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:AL
Practice Address - Zip Code:30329
Practice Address - Country:US
Practice Address - Phone:404-778-5234
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA044278207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA111238ASCAMedicare ID - Type UnspecifiedMEDICARE FACILITY NUMBER