Healthcare Provider Details

I. General information

NPI: 1508795683
Provider Name (Legal Business Name): ATLANTA CHILDREN'S GENERAL ANESTHESIA DENTISTRY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2026
Last Update Date: 05/15/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 CORPORATE CENTER DRIVE
MARROW GA
30260
US

IV. Provider business mailing address

8977 S 1300 W STE 475
WEST JORDAN UT
84088-9274
US

V. Phone/Fax

Practice location:
  • Phone: 301-494-3000
  • Fax:
Mailing address:
  • Phone: 301-494-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: JEFF WHEELER
Title or Position: CEO
Credential:
Phone: 301-494-3000