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General NPI Number Information
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NPI Number | 1356226203
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Entity Type | Individual
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Provider Name | RAVEN CHILDS
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Gender | Male
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Dates
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Enumeration Date | 08/08/2025
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Last Update Date | 08/08/2025
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Provider Practice Location Address
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Address Line | 260 PEACHTREE ST NW STE 2200
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City | ATLANTA
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State | GA
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Zip | 30303-1292
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Country | US
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Telephone | 404-429-8377
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Fax |
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Provider Business Mailing Address
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Address Line | 1122 OAK KNOLL TER SE
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City | ATLANTA
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State | GA
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Zip | 30315-5214
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Country | US
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Telephone | 404-429-8377
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Fax | 404-429-8377
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 247ZC0005X
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Taxonomy Name | Clinical Laboratory Director (Non-physician)
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License Number | 11D2327258
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License Number State | GA
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