Basic Information
| Provider Information | |||||||||
| NPI: | 1972896397 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MOREHOUSE SCHOOL OF MEDICINE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 720 WESTVIEW DR SW | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303101458 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4047521857 | ||||||||
| FaxNumber: | 4047561313 | ||||||||
| Practice Location | |||||||||
| Address1: | 720 WESTVIEW DR SW | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303101458 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4047521857 | ||||||||
| FaxNumber: | 4047561313 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2011 | ||||||||
| LastUpdateDate: | 05/18/2011 | ||||||||
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| AuthorizedOfficialLastName: | KIZZIE | ||||||||
| AuthorizedOfficialFirstName: | COYEA | ||||||||
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| AuthorizedOfficialTitleorPosition: | ASSOCIATE DIRECTOR, GME | ||||||||
| AuthorizedOfficialTelephone: | 4047521857 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | MHA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282NC0060X | 001974 | GA | Y | Hospitals | General Acute Care Hospital | Critical Access |
No ID Information.