Provider Demographics
NPI:1447020268
Name:GRADY MEMORIAL HOSPITAL CORPORATION
Entity type:Organization
Organization Name:GRADY MEMORIAL HOSPITAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXEC DIRECTOR AMBULATORY PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:MARY KATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHEELEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-616-5711
Mailing Address - Street 1:80 JESSE HILL JR DR SE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30303-3031
Mailing Address - Country:US
Mailing Address - Phone:404-616-1000
Mailing Address - Fax:
Practice Address - Street 1:3896 PRINCETON LAKES WAY SW RM 126
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-5510
Practice Address - Country:US
Practice Address - Phone:404-616-8630
Practice Address - Fax:404-616-6070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-03
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy