Provider Demographics
NPI:1043352016
Name:GEORGIA INSTITUTE OF TECHNOLOGY STAMPS HEALTH SERVICES
Entity type:Organization
Organization Name:GEORGIA INSTITUTE OF TECHNOLOGY STAMPS HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, STAMPS HEALTH SERVICES
Authorized Official - Prefix:DR
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:E
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-894-2587
Mailing Address - Street 1:740 FERST DRIVE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30332-0470
Mailing Address - Country:US
Mailing Address - Phone:404-894-2587
Mailing Address - Fax:404-894-7480
Practice Address - Street 1:740 FERST DRIVE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30332-0470
Practice Address - Country:US
Practice Address - Phone:404-894-2587
Practice Address - Fax:404-894-7480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health