GRADY HEALTH SYSTEM (NPI# 1013211564) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1013211564 |
| Entity Type | Organization |
| Organization Name | GRADY HEALTH SYSTEM |
| Practice Address |
180 Victoria Dr Fayetteville GA 30214-1163 |
| Practice Telephone | 4043797052 |
| Mailing Telephone | 4043797052 |
| Enumeration Date | 2010-12-26 |
| Last Update Date | 2010-12-26 |
| Authorized Official Name | MRS. LATOYA BOOTH WISE (ANESTHETIST) |
| Authorized Official Telephone | 4043797052 |
| Authorized Official Credential | CRNA |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 282NC0060X |
General Acute Care Hospital Specialization: Critical Access |
161834 | GA | Hospitals |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497139794 | Grady Health System | General Acute Care Hospital | 80 Jesse Hill Jr Dr Se, Atlanta, GA 30303-3031 | 2015-07-16 |
| 1295015279 | Grady Health System | General Acute Care Hospital | 80 Jesse Hill Jr Dr Se, Atlanta, GA 30303-3031 | 2011-08-23 |
| 1356594188 | Grady Health System | General Acute Care Hospital | 80 Jesse Hill Jr Dr Se, Chief Anesthetist-po 26-074, Atlanta, GA 30303-3031 | 2008-10-24 |
| 1366400723 | Grady Health System | Clinic/Center | 80 Jesse Hill Jr Dr Se, Atlanta, GA 30303-3031 | 2006-05-03 |
| 1699737445 | Grady Health System | Clinic/Center | 80 Jesse Hill Jr Drive, Hughes Spalding Children's Hospital, Atlanta, GA 30303 | 2006-04-06 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | GRADY HEALTH SYSTEM | 745 Memorial Dr Se, Atlanta, GA 30316-1185 |
| Street Address |
180 VICTORIA DR |
| City | FAYETTEVILLE |
| State | GA |
| Zip Code | 30214-1163 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831456284 | Latoya Leigh Wise | Nurse Anesthetist, Certified Registered | 180 Victoria Dr, Fayetteville, GA 30214-1163 | 2012-04-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548872468 | Phyllis Kelly Wood | Nurse Practitioner | 217 Banks Rd, Suite 31, Fayetteville, GA 30214 | 2020-08-21 |
| 1073139317 | Tyisha Salter Scott | Counselor | 110 Habersham Drive, Suite 142, Fayetteville, GA 30214 | 2020-06-23 |
| 1194341412 | Camille Franncine Bolton | Physical Therapist | 500 Floy Farr Parkway, Suite 303, Fayetteville, GA 30214 | 2020-06-23 |
| 1205465895 | Gillian Vaughan Heard | Physician Assistant | 1275 Ga-54 #201, Fayetteville, GA 30214 | 2020-04-06 |
| 1881234557 | Peach Fits,inc | Mastectomy Fitter | 285 Glynn Street South, Suites 102 and 104, Fayetteville, GA 30214 | 2020-01-10 |
| 1255981072 | Delta Healthcare Providers | Clinic/Center | 1275 W Lanier Ave, #200, Fayetteville, GA 30214 | 2019-09-13 |
| 1861965592 | Hierarchy for Wellness | Specialist | 805 S Glynn St Bldg 127 142, Fayetteville, GA 30214 | 2019-01-04 |
| 1356810634 | Fayette Dental Group PC | Clinic/Center | 720 W Lanier Ave, Fayetteville, GA 30214 | 2018-11-16 |
| 1891263299 | Mattie Mae Farmer Clark | Specialist/Technologist, Other | Piedmont Fayette Hospital, 1255 Highway 54 West, Fayetteville, GA 30214 | 2018-11-05 |
| 1093293607 | Allyson Holland | Pharmacist | 880 Highway 85 South, Fayetteville, GA 30214 | 2018-08-06 |
| Find all providers in zip 30214 | ||||
| Taxonomy Code | 282NC0060X |
| Grouping | Hospitals |
| Classification | General Acute Care Hospital |
| Specialization | Critical Access |
| Definition to come. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043601404 | Cumberland County Hospital System | General Acute Care Hospital | 1638 Owen Dr, Fayetteville, NC 28304-3424 | 2015-02-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780046425 | Rasheeda Brown | General Acute Care Hospital | 362 E.g. Miles Parkway, Hinesville, GA 31310-0919 | 2016-03-22 |
| 1073927117 | Polk Medical Center, Inc | General Acute Care Hospital | 2360 Rockmart Hwy, Cedartown, GA 30125-6029 | 2014-06-17 |
| 1174800114 | Emory University Hospital | General Acute Care Hospital | 1355 Clifton Rd Ne, Atlanta, GA 30322-1013 | 2011-11-04 |
| 1417264292 | Angela Marie Barco | General Acute Care Hospital | 3486 Peach Orchard Rd Ste 200, Augusta, GA 30906 | 2010-09-01 |
| 1780880583 | Wheeler County Hospital | General Acute Care Hospital | 111 North 3rd Street, Glenwood, GA 30428 | 2007-06-27 |
| 1609078047 | Medical College of Georgia | General Acute Care Hospital | 1120 15th St # Baa-5407, Augusta, GA 30912-0004 | 2007-06-05 |
| 1982821971 | Carl Vison Va Medical Center | General Acute Care Hospital | 48 Blueberry Farm Road, Adrian, GA 31002 | 2007-04-19 |
| 1326191180 | Professional Resources Management of Rabun, LLC | General Acute Care Hospital | 162 Legacy Pt, Clayton, GA 30525-5354 | 2007-01-18 |
| 1184771586 | Lower Oconee Community Hospital Inc | General Acute Care Hospital | 111 N 3rd Street, P O Bx 398, Glenwood, GA 30428 | 2007-01-05 |
| 1558423202 | Preferred Anesthesia Consultants | General Acute Care Hospital | 306 E 2nd Ave, Rome, GA 30161-3222 | 2006-12-15 |
| Find all providers with the same taxonomy | ||||
| City | FAYETTEVILLE |
| Zip Code | 30214 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.