Healthcare Provider Details

I. General information

NPI: 1417134743
Provider Name (Legal Business Name): EMORY UNIVERSITY DEPARTMENT OF PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2008
Last Update Date: 01/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49 JESSE HILL JR DR SE
ATLANTA GA
30303-3049
US

IV. Provider business mailing address

49 JESSE HILL JR DR SE
ATLANTA GA
30303-3049
US

V. Phone/Fax

Practice location:
  • Phone: 404-778-1440
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC2000X
TaxonomyChildren's Hospital
License Number002852
License Number StateGA

VIII. Authorized Official

Name: DR. SUSIE BUCHTER
Title or Position: PROGRAM DIRECTOR
Credential: MD
Phone: 404-778-1440