Directory information, not recipient confirmation. Fax numbers can change and differ by department, location, form, or plan. Confirm this destination directly with Piedmont Atlanta Hospital before sending sensitive documents. FaxFlow is not affiliated with this organization.
Piedmont Atlanta Hospital fax number
(833) 605-2063
Medical Records / Records Request
Used for: Authorization for Use/Disclosure of Protected Health Information (PHI) - PHI release
Fax destination details
- Department
- Medical Records / Records Request
- Purpose
- Authorization for Use/Disclosure of Protected Health Information (PHI) - PHI release
- Form
- Authorization For Use/Disclosure of Protected Health Information
- Address
- Piedmont Atlanta Hospital, 1968 Peachtree Road NW, Atlanta, GA 30309, United States
- Voice phone
- 404-605-5000
- Website
- Visit organization website
Before you send
- Confirm that this exact department handles your document or request.
- Check the organization website or call its main line for the current fax number.
- Include a cover sheet and any case, member, claim, or form reference required.
- Keep the delivery confirmation with your submission records.
Submit a completed PHI authorization. Fax your ID and the completed form to the facility, or email RecordsRequest@piedmont.org. The authorization is valid for 90 days from the signing date. There may be fees for providing the information, but records for treatment purposes may be faxed to the patient’s healthcare provider at no charge.
Review official form instructionsSources and verification
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