Basic Information
| Provider Information | |||||||||
| NPI: | 1396813838 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GREENBAUM | ||||||||
| FirstName: | ADAM | ||||||||
| MiddleName: | B. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | EMORY HEALTHCARE 1364 CLIFTON RD NE SUITE D422 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303220001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4047127667 | ||||||||
| FaxNumber: | 4047125622 | ||||||||
| Practice Location | |||||||||
| Address1: | EMORY UNIVERSITY HOSPITAL 1364 CLIFTON RD NE | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30322 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3139169106 | ||||||||
| FaxNumber: | 3139161249 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/01/2006 | ||||||||
| LastUpdateDate: | 08/22/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 059304 | MI | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RC0000X | 080063 | GA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207R00000X | 059304 | MI | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RI0011X | 080063 | GA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology |
ID Information
| ID | Type | State | Issuer | Description | 060H264410 | 01 | BLUE CROSS-BLUE CROSS | OTHER | 410065910 | 05 | MI | MEDICAID | AG059304 | 01 | CHAMPUS-CHAMPUS | OTHER | AG059304 | 01 | COMMERCIAL-COMMERCIAL NUMBER | OTHER |