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General NPI Number Information
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NPI Number | 1881764553
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Entity Type | Organization
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Legal Business Name | CHILDRENS HEALTHCARE OF ATLANTA SURGERY CENTER AT MERIDIAN MARK PLAZA
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Dates
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Enumeration Date | 11/09/2006
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Last Update Date | 01/16/2025
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Provider Practice Location Address
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Address Line | 5445 MERIDIAN MARKS RD NE SUITE 340
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City | ATLANTA
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State | GA
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Zip | 30342-4763
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Country | US
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Telephone | 404-785-5650
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Fax |
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Provider Business Mailing Address
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Address Line | 1575 NE EXPRESSWAY
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City | ATLANTA
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State | GA
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Zip | 30329-2317
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Country | US
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Telephone | 404-785-7876
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Fax |
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Authorized Official
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Title or Position | MGR, PROVIDER ENROLLMENT
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Name | MANAGED CARE
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Credential |
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Telephone | 404-785-5437
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 060-256
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License Number State | GA
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