Provider Demographics
NPI:1770691115
Name:EMORY-ADVENTIST INC
Entity Type:Organization
Organization Name:EMORY-ADVENTIST INC
Other - Org Name:EMORY-ADVENTIST HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:HAZEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-436-3162
Mailing Address - Street 1:3949 S COBB DR SE
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-6342
Mailing Address - Country:US
Mailing Address - Phone:770-434-0710
Mailing Address - Fax:770-432-4260
Practice Address - Street 1:3949 S COBB DR SE
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-6342
Practice Address - Country:US
Practice Address - Phone:770-434-0710
Practice Address - Fax:770-432-4260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-27
Last Update Date:2010-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA033-493282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00001702AMedicaid
GA100086OtherBLUE CROSS
GA5009000OtherUNITED HEALTH CARE
GA00001702AMedicaid