Healthcare Provider Details

I. General information

NPI: 1114256427
Provider Name (Legal Business Name): EMORY CHILDREN'S CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2009
Last Update Date: 12/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2015 UPPERGATE DR SUITE 208
ATLANTA GA
30322-0001
US

IV. Provider business mailing address

550 PEACHTREE ST NE
ATLANTA GA
30308-2208
US

V. Phone/Fax

Practice location:
  • Phone: 404-727-2966
  • Fax: 404-727-3236
Mailing address:
  • Phone: 404-727-2966
  • Fax: 404-727-3236

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License NumberR61462
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License NumberRN61462
License Number StateGA

VIII. Authorized Official

Name: DR. ANN D CRITZ
Title or Position: ASSOCIATE PROFESSOR OF PEDIATRICS
Credential: M.D.
Phone: 404-686-8136