Provider Demographics
NPI:1295902955
Name:MOREHOUSE SCHOOL OF MEDICINE
Entity type:Organization
Organization Name:MOREHOUSE SCHOOL OF MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISSATNT DIRECTOR, GME
Authorized Official - Prefix:MS
Authorized Official - First Name:COYEA
Authorized Official - Middle Name:ET
Authorized Official - Last Name:KIZZIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-752-1500
Mailing Address - Street 1:720 WESTVIEW DR SW
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:770-752-1500
Mailing Address - Fax:
Practice Address - Street 1:720 WESTVIEW DR SW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30310-1458
Practice Address - Country:US
Practice Address - Phone:770-752-1500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-13
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA001002283Q00000X, 273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
No283Q00000XHospitalsPsychiatric Hospital