Provider Demographics
NPI:1548680796
Name:EMORY PHYSICIANS GROUP, LLC
Entity type:Organization
Organization Name:EMORY PHYSICIANS GROUP, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:VICENT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-778-5352
Mailing Address - Street 1:PO BOX 102404
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91189-2404
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:22 14TH STREET NW
Practice Address - Street 2:SPACE 129
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309
Practice Address - Country:US
Practice Address - Phone:404-504-6554
Practice Address - Fax:404-999-7964
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE EMORY CLINIC, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-04-25
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center