NPIMap

Organization Active NPI

Grady Memorial Hospital Corporation

Doing business as Grady Infectious Disease Pharmacy

  • Community/Retail Pharmacy
  • Atlanta, GA
National Provider Identifier
1083629638
Registry record updated Dec 21, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
7146 Issued in GA
Legal business name
GRADY MEMORIAL HOSPITAL CORPORATION
Doing business as
Grady Infectious Disease Pharmacy
Practice address
341 Ponce de Leon Ave NE RM 110
Atlanta, GA 30308-2012
Phone
(404) 616-2466
Fax
(404) 616-9777
NPI assigned
Jul 30, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 21, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Valaura Hallman
Title
Director of Pharmacy Administration
Phone
(404) 616-3576

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X 7146 GA Primary

Addresses

Primary practice location

341 Ponce de Leon Ave NE RM 110
Atlanta, GA 30308-2012

Mailing address

Pharmacy Administration-26041
80 Jesse Hill Jr Drive
Atlanta, GA 30303
Phone (404) 616-3576

Other identifiers 2

IdentifierTypeStateIssuer
937307EMedicaidGA
2131376OtherPK

Other names 1

  • Grady Infectious Disease Pharmacy Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Grady Memorial Hospital Corporation12 organizations share this tax ID, including this one

Other organizations with this tax ID 11

Organizations that report the same tax identification number in the National Provider Directory.

Locations

341 Ponce de Leon Ave NE
Rm 110
Atlanta, GA 30308
Phone (404) 616-2466

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1154217600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1482278400000",
    "number": "1083629638",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PHARMACY ADMINISTRATION-26041",
            "address_2": "80 JESSE HILL JR DRIVE",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "30303",
            "telephone_number": "404-616-3576",
            "fax_number": "404-616-6070"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "341 PONCE DE LEON AVE NE RM 110",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303082012",
            "telephone_number": "404-616-2466",
            "fax_number": "404-616-9777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRADY MEMORIAL HOSPITAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-30",
        "last_updated": "2016-12-21",
        "status": "A",
        "authorized_official_last_name": "HALLMAN",
        "authorized_official_first_name": "VALAURA",
        "authorized_official_title_or_position": "DIRECTOR OF PHARMACY ADMINISTRATION",
        "authorized_official_telephone_number": "404-616-3576"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "GA",
            "license": "7146",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "937307E",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2131376",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Grady Infectious Disease Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Atlanta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.