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DSH110079G GRADY MEMORIAL HOSPITAL (Active)
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Main Details
Name
GRADY MEMORIAL HOSPITAL
Subdivision Name
Hughes Spalding Childrens Hospital
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH110079G
Medicare Provider Number
110079
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
9/5/2007
Participating Start Date
10/1/2002
Participating Approval Date
9/5/2007
Last Recertification Date
9/3/2024
Contacts
Authorizing Official
Grady Health System
John Haupert, Chief Executive Officer
(404) 616-4254
Primary Contact
Grady Health System
Kelcy Susannah Freeman, Pharmacy Program Coordinator
(404) 616-5909
Addresses
Street Address
35 Jesse Hill Jr Drive SE
Atlanta, GA 30303-3032
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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10/28/03 UPDATED ADDR (WAS 69 JESSE HILL JR DRIVE, SE)
09/05/2007
May 2025
May 2025
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