Provider Demographics
NPI:1558443085
Name:ATLANTA HOSPITAL AUTHORITY
Entity Type:Organization
Organization Name:ATLANTA HOSPITAL AUTHORITY
Other - Org Name:ATLANTA MEMORIAL HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:TOM
Authorized Official - Middle Name:
Authorized Official - Last Name:CROW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-799-3000
Mailing Address - Street 1:1007 S WILLIAM ST
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:TX
Mailing Address - Zip Code:75551-3245
Mailing Address - Country:US
Mailing Address - Phone:903-799-3000
Mailing Address - Fax:903-799-3005
Practice Address - Street 1:1007 S WILLIAM ST
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:TX
Practice Address - Zip Code:75551-3245
Practice Address - Country:US
Practice Address - Phone:903-799-3000
Practice Address - Fax:903-799-3005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2011-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX133255307Medicaid
TX133255307Medicaid