Provider Demographics
NPI:1225096837
Name:THE CHILDREN'S & ADOLESCENT MEDICAL CENTER PC
Entity Type:Organization
Organization Name:THE CHILDREN'S & ADOLESCENT MEDICAL CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARION
Authorized Official - Middle Name:M
Authorized Official - Last Name:MCCELLAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:404-366-3636
Mailing Address - Street 1:4905 COURTNEY DR
Mailing Address - Street 2:
Mailing Address - City:FOREST PARK
Mailing Address - State:GA
Mailing Address - Zip Code:30297-1427
Mailing Address - Country:US
Mailing Address - Phone:404-366-3636
Mailing Address - Fax:404-362-0808
Practice Address - Street 1:4905 COURTNEY DR
Practice Address - Street 2:
Practice Address - City:FOREST PARK
Practice Address - State:GA
Practice Address - Zip Code:30297-1427
Practice Address - Country:US
Practice Address - Phone:404-366-3636
Practice Address - Fax:404-362-0808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0084972080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty