Provider Demographics
NPI:1316456825
Name:CHILDREN'S HEALTHCARE OF ATLANTA AT SCOTTISH RITE
Entity type:Organization
Organization Name:CHILDREN'S HEALTHCARE OF ATLANTA AT SCOTTISH RITE
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:30329-2401
Mailing Address - Country:US
Mailing Address - Phone:404-785-7876
Mailing Address - Fax:404-785-7932
Practice Address - Street 1:605 BIG SHANTY ROAD, NW
Practice Address - Street 2:STE 100
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-3646
Practice Address - Country:US
Practice Address - Phone:404-785-3229
Practice Address - Fax:404-785-5690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-27
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit