Provider Demographics
NPI:1043485584
Name:THE CHILDRENS CLINIC
Entity Type:Organization
Organization Name:THE CHILDRENS CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HARVEY
Authorized Official - Middle Name:J
Authorized Official - Last Name:DANITS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-960-9999
Mailing Address - Street 1:1000 CORPORATE CENTER DR
Mailing Address - Street 2:SUITE 220
Mailing Address - City:MORROW
Mailing Address - State:GA
Mailing Address - Zip Code:30260-4180
Mailing Address - Country:US
Mailing Address - Phone:770-960-9999
Mailing Address - Fax:770-960-0931
Practice Address - Street 1:1000 CORPORATE CENTER DR
Practice Address - Street 2:SUITE 220
Practice Address - City:MORROW
Practice Address - State:GA
Practice Address - Zip Code:30260-4180
Practice Address - Country:US
Practice Address - Phone:770-960-9999
Practice Address - Fax:770-960-0931
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-25
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA15242174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000509539AMedicaid