Provider Demographics
NPI:1235161464
Name:CHILDREN'S HEALTHCARE OF ATLANTA MARIETTA PRIMARY CARE
Entity Type:Organization
Organization Name:CHILDREN'S HEALTHCARE OF ATLANTA MARIETTA PRIMARY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:STAFF PEDIATRICAN
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:JUNG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-785-8200
Mailing Address - Street 1:895 CANTON RD NE BLDG 100
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-8935
Mailing Address - Country:US
Mailing Address - Phone:404-785-8220
Mailing Address - Fax:404-785-8257
Practice Address - Street 1:895 CANTON RD NE BLDG 100
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-8935
Practice Address - Country:US
Practice Address - Phone:404-785-8220
Practice Address - Fax:404-785-8257
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA040933261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center