Provider Demographics
NPI:1932503711
Name:EMORY EMPLOYER BASED HEALTH SERVICES
Entity Type:Organization
Organization Name:EMORY EMPLOYER BASED HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:VICENT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-778-5352
Mailing Address - Street 1:101 W PONCE DE LEON AVE
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-2542
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1 COCA COLA PLZ NW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30313
Practice Address - Country:US
Practice Address - Phone:404-251-1850
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EMORY SPECIALTY ASSOCIATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-10-22
Last Update Date:2018-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center