Provider Demographics
NPI:1750326617
Name:EMORY UNIVERSITY HEALTH SERVICES
Entity Type:Organization
Organization Name:EMORY UNIVERSITY HEALTH SERVICES
Other - Org Name:STUDENT HEALTH SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:HUEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-712-8652
Mailing Address - Street 1:1525 CLIFTON RD NE
Mailing Address - Street 2:ROOM 272
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30322-4200
Mailing Address - Country:US
Mailing Address - Phone:404-712-8652
Mailing Address - Fax:404-727-3859
Practice Address - Street 1:1525 CLIFTON RD NE
Practice Address - Street 2:ROOM 272
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322-4200
Practice Address - Country:US
Practice Address - Phone:404-712-8652
Practice Address - Fax:404-727-3859
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA050962261QS1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAA49356Medicare UPIN