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DSH110078A EMORY UNIVERSITY HOSPITAL MIDTOWN (Active)
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Main Details
Name
EMORY UNIVERSITY HOSPITAL MIDTOWN
Subdivision Name
Winship Cancer Institute Infusion Center at Clifton Road Campus
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH110078A
Medicare Provider Number
110078
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
11/30/2006
Participating Start Date
1/1/2007
Participating Approval Date
11/30/2006
Last Recertification Date
8/23/2024
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
1365 Clifton Rd NE, Bldg C, Plaza Level
Atlanta, GA 30322
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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7/31/09 UPDATED ENTITY NAME (WAS EMORY CRAWFORD LONG HOSPITAL); 1/22/07 - ADDR CHANGE (WAS 1365 CLIFTON NE B1524)02/24/2011 CHANGED SUBDIV. NAME(WAS EMORY INFUSION CENTER)
02/24/2011
7/31/09 UPDATED ENTITY NAME (WAS EMORY CRAWFORD LONG HOSPITAL); 1/22/07 - ADDR CHANGE (WAS 1365 CLIFTON NE B1524)02/24/2011 CHANGED SUBDIV. NAME(WAS EMORY INFUSION CENTER)
11/30/2006
April 2025
April 2025
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