Provider Demographics
NPI:1811765902
Name:THE EMORY CLINIC INC
Entity type:Organization
Organization Name:THE EMORY CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICIER
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:R
Authorized Official - Last Name:MASCIOTRA
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:404-778-7552
Mailing Address - Street 1:2201 HENDERSON MILL RD NE STE 160
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30345-2711
Mailing Address - Country:US
Mailing Address - Phone:404-778-5079
Mailing Address - Fax:
Practice Address - Street 1:4555 N SHALLOWFORD RD
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30338-6403
Practice Address - Country:US
Practice Address - Phone:404-778-4000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EMORY CLINIC INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-12-18
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical