Provider Demographics
NPI:1306197702
Name:CHILDREN'S HEALTHCARE OF ATLANTA
Entity type:Organization
Organization Name:CHILDREN'S HEALTHCARE OF ATLANTA
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 1:2270 DULUTH HWY
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30097-4010
Practice Address - Country:US
Practice Address - Phone:404-785-2540
Practice Address - Fax:404-785-2541
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHILDREN'S HEALTHCARE OF ATLANTA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-09-25
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit