Healthcare Provider Details

I. General information

NPI: 1740337153
Provider Name (Legal Business Name): CHILDREN'S HEALTHCARE OF ATLANTA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3795 MANSELL RD
ALPHARETTA GA
30022-8247
US

IV. Provider business mailing address

3845 GREY ABBEY DR
ALPHARETTA GA
30022-6482
US

V. Phone/Fax

Practice location:
  • Phone: 404-785-8540
  • Fax:
Mailing address:
  • Phone: 678-393-9108
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC2000X
TaxonomyChildren's Hospital
License Number051519
License Number StateGA

VIII. Authorized Official

Name: DR. DENNIS SULLIVAN
Title or Position: MEDICAL SUPERVISOR
Credential: MD
Phone: 404-785-8588