NPI 1780852921

Children's Clinic of Atlanta

Organisation Exclusive Provider Organization Atlanta, GA

Practice location

Address: 2967 a Grandview Ave NE, Atlanta, GA 30305
Phone: (404) 814-0733
Fax: (404) 814-0584
Mailing address: PO Box 11989, Atlanta, GA 30355-1989

Authorised official

Name: Nina Brazell Bass
Title: Owner
Phone: (404) 814-0733

Registered specialties

Exclusive Provider Organization Primary

Managed Care Organizations Taxonomy 302F00000X Licence 031559 (GA)

Other Exclusive Provider Organization providers in Georgia →

Registry record

NPI: 1780852921
Entity type: Organization
NPI issued: 11 Feb 2008
Record last updated: 11 Feb 2008

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.