Provider Demographics
NPI:1285932814
Name:SCOTTISH RITE CHILDREN'S MEDICAL CENTER
Entity type:Organization
Organization Name:SCOTTISH RITE CHILDREN'S MEDICAL CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER, PROVIDER ENROLLMENT
Authorized Official - Prefix:
Authorized Official - First Name:LOUETTA
Authorized Official - Middle Name:
Authorized Official - Last Name:CODY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-785-7876
Mailing Address - Street 1:1575 NE EXPRESSWAY
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30329-2311
Mailing Address - Country:US
Mailing Address - Phone:404-785-7928
Mailing Address - Fax:404-785-7932
Practice Address - Street 1:410 PEACHTREE PKWY
Practice Address - Street 2:SUITE 300
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-7066
Practice Address - Country:US
Practice Address - Phone:404-785-3229
Practice Address - Fax:404-785-5690
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHILDREN'S HEALTHCARE OF ATLANTA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-03-07
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit
No335E00000XSuppliersProsthetic/Orthotic Supplier