Provider Demographics
NPI:1356594188
Name:GRADY HEALTH SYSTEM
Entity type:Organization
Organization Name:GRADY HEALTH SYSTEM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF ANESTHETIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:RICHARDS
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:404-616-5519
Mailing Address - Street 1:80 JESSE HILL JR DR SE
Mailing Address - Street 2:CHIEF ANESTHETIST-PO 26-074
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30303-3031
Mailing Address - Country:US
Mailing Address - Phone:404-616-5519
Mailing Address - Fax:404-616-9213
Practice Address - Street 1:80 JESSE HILL JR DR SE
Practice Address - Street 2:CHIEF ANESTHETIST-PO 26-074
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30303-3031
Practice Address - Country:US
Practice Address - Phone:404-616-5519
Practice Address - Fax:404-616-9213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-24
Last Update Date:2008-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA4024282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital