Provider Demographics
NPI:1396900247
Name:CHILDRENS HEALTHCARE OF ATLANTA
Entity type:Organization
Organization Name:CHILDRENS HEALTHCARE OF ATLANTA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:404-785-1882
Mailing Address - Street 1:494 RISING SUN PATH
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-3169
Mailing Address - Country:US
Mailing Address - Phone:770-338-7476
Mailing Address - Fax:770-338-7476
Practice Address - Street 1:494 RISING SUN PATH
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30043-3169
Practice Address - Country:US
Practice Address - Phone:770-338-7476
Practice Address - Fax:770-338-7476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-21
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN1588753140N1450X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3140N1450XNursing & Custodial Care FacilitiesSkilled Nursing FacilityNursing Care, Pediatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAXKH511A63954-01OtherBLUE CROSS/ BLUE SHIELD