Healthcare Provider Details

I. General information

NPI: 1326119405
Provider Name (Legal Business Name): CHILDREN'S HEALTHCARE OF ATLANTA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 07/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1645 TULLIE CIR NE
ATLANTA GA
30329-2304
US

IV. Provider business mailing address

1269 E ROCK SPRINGS RD NE
ATLANTA GA
30306-2266
US

V. Phone/Fax

Practice location:
  • Phone: 404-785-7141
  • Fax:
Mailing address:
  • Phone: 404-876-7457
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146D00000X
TaxonomyPersonal Emergency Response Attendant
License Number45360
License Number StateGA

VIII. Authorized Official

Name: MARK J WARD
Title or Position: ASSISTANT PROFESSOR
Credential: MD
Phone: 404-876-7457