NPIMap

Organization Active NPI

Grady Memorial Hospital Corporation

  • Community/Retail Pharmacy
  • Atlanta, GA
National Provider Identifier
1316294713
Registry record updated Feb 10, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
PHRE009852 Issued in GA
Legal business name
GRADY MEMORIAL HOSPITAL CORPORATION
Doing business as
Grady Behavioral Health Center Pharmacy
Practice address
10 Park Place
Atlanta, GA 30303
Phone
(404) 616-0888
Fax
(404) 616-0899
NPI assigned
Aug 6, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 10, 2016

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

Authorized official

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X PHRE009852 GA Primary

Addresses

Primary practice location

10 Park Place
Atlanta, GA 30303

Mailing address

PO Box 26041
80 Jesse Hill Jr Drive
Atlanta, GA 30303-0001
Phone (404) 616-3576

Other identifiers 2

IdentifierTypeStateIssuer
003127124AMedicaidGA
2136347OtherPK

Other names 1

  • Grady Behavioral Health Center Pharmacy Doing business as

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
11D2057625Grady HLTH System O/P Behavioral HLTH Center10 Park Place, North East, Atlanta, GA 30303Certificate of waiverMay 29, 2027

National Provider Directory

National Provider Directory
Tax ID family
Grady Memorial Hospital Corporation15 organizations share this tax ID, including this one

Other organizations with this tax ID 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1344211200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1455062400000",
    "number": "1316294713",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 26041",
            "address_2": "80 JESSE HILL JR DRIVE",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303030001",
            "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": "10 PARK PLACE",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "30303",
            "telephone_number": "404-616-0888",
            "fax_number": "404-616-0899"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRADY MEMORIAL HOSPITAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-08-06",
        "last_updated": "2016-02-10",
        "status": "A",
        "authorized_official_last_name": "HALLMAN",
        "authorized_official_first_name": "VALAURA",
        "authorized_official_title_or_position": "DIRECTOR PHARMACY ADMINISTRATI",
        "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": "PHRE009852",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003127124A",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2136347",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Grady Behavioral Health Center 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 Feb 10, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.