Provider Demographics
NPI:1659401487
Name:MOREHOUSE MEDICAL ASSOCIATE
Entity type:Organization
Organization Name:MOREHOUSE MEDICAL ASSOCIATE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JASMINE
Authorized Official - Middle Name:S
Authorized Official - Last Name:BAJNATH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-756-5752
Mailing Address - Street 1:720 WESTVIEW DR SW STE 100
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30310-1458
Mailing Address - Country:US
Mailing Address - Phone:404-756-5752
Mailing Address - Fax:404-756-5274
Practice Address - Street 1:1513 CLEVELAND AVE
Practice Address - Street 2:500
Practice Address - City:EAST POINT
Practice Address - State:GA
Practice Address - Zip Code:30344-6947
Practice Address - Country:US
Practice Address - Phone:404-752-1000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2018-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA51261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care