Provider Demographics
NPI:1306856505
Name:ATLANTA CHILDREN'S CLINICAL CENTER, P.C.
Entity Type:Organization
Organization Name:ATLANTA CHILDREN'S CLINICAL CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOY
Authorized Official - Middle Name:A
Authorized Official - Last Name:MAXEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-261-2666
Mailing Address - Street 1:3091 MAPLE DR NE
Mailing Address - Street 2:SUITE 315
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305-2610
Mailing Address - Country:US
Mailing Address - Phone:404-261-2666
Mailing Address - Fax:404-261-2669
Practice Address - Street 1:3091 MAPLE DR NE
Practice Address - Street 2:SUITE 315
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30305-2610
Practice Address - Country:US
Practice Address - Phone:404-261-2666
Practice Address - Fax:404-261-2669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA027731208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty