Provider Demographics
NPI:1508066598
Name:EMORY HEALTHCARE
Entity Type:Organization
Organization Name:EMORY HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HOSPITALIST
Authorized Official - Prefix:DR
Authorized Official - First Name:QURAT-UL-AIN
Authorized Official - Middle Name:
Authorized Official - Last Name:KIZILBASH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-686-7869
Mailing Address - Street 1:1364 CLIFTON RD NE
Mailing Address - Street 2:HOSPITAL MEDICINE BOX M7
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30322-1059
Mailing Address - Country:US
Mailing Address - Phone:404-778-3914
Mailing Address - Fax:404-778-5495
Practice Address - Street 1:1364 CLIFTON RD NE
Practice Address - Street 2:HOSPITAL MEDICINE BOX M7
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322-1064
Practice Address - Country:US
Practice Address - Phone:404-778-3914
Practice Address - Fax:404-778-5495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-19
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA59808282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA=========Medicaid