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DSH110115N WellStar ATLANTA MEDICAL CENTER (Terminated)
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Main Details
Name
WellStar ATLANTA MEDICAL CENTER
Subdivision Name
CATSCAN
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH110115N
Medicare Provider Number
110115
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/11/2017
Participating Start Date
4/1/2017
Participating Approval Date
3/10/2017
Last Recertification Date
8/25/2021
Termination Date
Termination Reason
7/1/2022
Site closure
Contacts
Authorizing Official
Wellstar Atlanta Medical Center
Thomas M Morris, Chief Operating Officer
(770) 853-9009
Primary Contact
WELLSTAR ATLANTA MEDICAL CENTER
Tonya Gifford, Pharmacy Director
(404) 466-8219
Addresses
Street Address
1170 Cleveland Avenue
East Point, GA 30344
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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