MEDICARE: CHILDRENS HEALTHCARE OF ATLANTA CARDIOLOGY INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2080P0202X	Pediatric Cardiology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235148727
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHILDRENS HEALTHCARE OF ATLANTA CARDIOLOGY INC

Provider Business Mailing Address
First Line	:	2970 BRANDYWINE RD STE 125
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30341-5528
Country	:	US
Telephone Number	:	404-256-2593
Fax Number	:	770-488-9401

Provider Business Practice Location Address
First Line	:	2970 BRANDYWINE RD STE 125
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30341-5528
Country	:	US
Telephone Number	:	404-256-2593
Fax Number	:	770-488-9401

Authorized Official
Title or Position	:	DIRECTOR
Name	:	WILLIAM COLE
Credential	:
Telephone Number	:	404-694-1700

Provider Enumeration Date	:	08/05/2006
Last Update Date	:	04/17/2024

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