Healthcare Provider Details

I. General information

NPI: 1073772919
Provider Name (Legal Business Name): CHILDREN'S HEALTHCARE OF ATLANTA AT HUGHES SPALDING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2008
Last Update Date: 06/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 JESSE HILL JR DR SE
ATLANTA GA
30303-3032
US

IV. Provider business mailing address

1584 TULLIE CIR NE
ATLANTA GA
30329-2311
US

V. Phone/Fax

Practice location:
  • Phone: 404-785-9500
  • Fax:
Mailing address:
  • Phone: 404-785-7928
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: TOBY THOMAS
Title or Position: VICE PRESIDENT MANAGED CARE
Credential:
Phone: 404-785-7914