Provider Demographics
NPI:1356935639
Name:MSM HEALTH EQUITY FOR ALL LIVES STUDENT-RUN FREE CLINIC
Entity type:Organization
Organization Name:MSM HEALTH EQUITY FOR ALL LIVES STUDENT-RUN FREE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JASMINE
Authorized Official - Middle Name:
Authorized Official - Last Name:BAJNATH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-756-1400
Mailing Address - Street 1:720 WESTVIEW DR SW STE 275550
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:404-756-1400
Mailing Address - Fax:
Practice Address - Street 1:455 LEE ST, SW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30310
Practice Address - Country:US
Practice Address - Phone:404-756-1209
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MOREHOUSE HEALTHCARE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-02-26
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care