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DSH110078AX EMORY UNIVERSITY HOSPITAL MIDTOWN (Active)
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Main Details
Name
EMORY UNIVERSITY HOSPITAL MIDTOWN
Subdivision Name
EP12 4TH FL NEURODIAGNOSTICS - EP12 4TH FL NEURODIAGNOSTICS
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH110078AX
Medicare Provider Number
110078
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/13/2025
Participating Start Date
4/1/2025
Participating Approval Date
1/27/2025
Last Recertification Date
Contacts
Authorizing Official
Emory Healthcare
Ava E Daunt-Samford, CFO
(404) 686-4918
Primary Contact
Emory Healthcare
Sydney Kchao, Corporate Director of Pharmacy, Business Operations and Finance
(404) 686-2147
Addresses
Street Address
12 EXECUTIVE PARK DR NE
FL 4
ATLANTA, GA 30329-2206
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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April 2025
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