Grady Memorial Hospital Corporation
Organization Active NPI Multi-Specialty Clinic/Center · Atlanta, GA
NPI 1649765686 · NPPES record last updated Jun 22, 2018
Key facts
- NPI
- 1649765686
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Multi-Specialty Clinic/Center 261QM1300X
- Legal business name
- GRADY MEMORIAL HOSPITAL CORPORATION
- Practice address
- 3896 Princeton Lakes Way
Atlanta, GA 30331 - Phone
- (404) 616-8880
- NPI assigned
- Jun 22, 2018
- Organization subpart
- Yes
- Parent organization (as reported)
- GRADY MEMORIAL HOSPITAL CORPORATION
Authorized official
- Name
- Tamara Anne Nilmeier
- Title
- Director of Revenue Cycle
- Phone
- (404) 616-8880
Owned or controlled facilities with NPI records 1
Other NPIs on the same Medicare enrollment 1
Other NPIs with the same Medicare PAC ID 6
Practitioners 447
-
Caryl Harris, FNP
-
Chrystal Hawkins, NP-BC
-
Sherese Hullaby, NP
-
Sepideh Zohreh, RDN
-
Paula Gertrude Adamson, M.D.
-
Michelle Harper Allen, M.D.
-
Sagar Bipin Amin, M.D.
-
Neeti Rajendra Bagadiya, M.D.
-
Patricia Balthazar, M.D.
-
Nabil Calisi, MD, MPH
-
Kelley W Carroll, M.D.
-
Renee E Corley, M.D.
-
Nicole King Cotton, M.D.
-
Ayushi Gupta, MD
-
Anna I Holbrook, MD
-
Gloria Hughes, MD
-
Oluwayemisi O Ibraheem, M.D.
-
Fatima Elizabeth Kasiah, M.D.
-
Julia J Liu, MD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in GA
All facility ownership & control disclosures 1
| Facility | Type | Role | Since |
|---|---|---|---|
| Crestview Health & Rehabilitation Center |
Skilled nursing facility | Operational/Managerial Control | Apr 22, 2008 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100723000311 | GA | Part B Supplier - Clinic/Group Practice | 7517032998 |
Receives reassigned benefits from 818 practitioners 1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Atlanta, GA; Chamblee, GA; College Park, GA; Decatur, GA; East Point, GA; Sandy Springs, GA; Union City, GA |
| O20181107003377 | GA | Part B Supplier - Clinic/Group Practice | 7517032998 |
Receives reassigned benefits from 49 practitioners Practice locations: Atlanta, GA |
National Provider Directory
- Part of
- Grady Memorial Hospital Corporation
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Multi-Specialty Clinic/Center | 261QM1300X | Yes |
Addresses
Primary practice location
3896 Princeton Lakes Way
Atlanta, GA 30331
Mailing address
80 Jesse Hill Jr Dr SE # 26042
Atlanta, GA 30303-3031
Phone (404) 616-8880
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 060-641 | Other | GA | BUSINESS PERMIT |
Other providers in Atlanta, GA
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- Grady Memorial Hospital Corporation
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- Grady Memorial Hospital Corporation
- Maureen Ann Grady Morales
All providers in Atlanta, GA · Multi-Specialty Clinic/Center in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 22, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.