Healthcare Provider Details

I. General information

NPI: 1972732212
Provider Name (Legal Business Name): SCOTTISH RITE CHILDREN'S MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2009
Last Update Date: 01/16/2025
Certification Date: 01/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 OLD MILTON PKWY
ALPHARETTA GA
30005-2423
US

IV. Provider business mailing address

1575 NE EXPRESSWAY
ATLANTA GA
30329-2401
US

V. Phone/Fax

Practice location:
  • Phone: 404-785-7917
  • Fax: 404-785-7932
Mailing address:
  • Phone: 404-785-7876
  • Fax: 404-785-7932

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code273Y00000X
TaxonomyRehabilitation Hospital Unit
License Number
License Number State

VIII. Authorized Official

Name: LOUETTA CODY
Title or Position: MANAGER, PROVIDER ENROLLMENT
Credential:
Phone: 404-785-7876