Provider Demographics
NPI:1326119405
Name:CHILDREN'S HEALTHCARE OF ATLANTA
Entity Type:Organization
Organization Name:CHILDREN'S HEALTHCARE OF ATLANTA
Other - Org Name:EMORY UNHIVERSITY COLLEGE OF MEDICINE
Other - Org Type:Other Name
Authorized Official - Title/Position:ASSISTANT PROFESSOR
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:J
Authorized Official - Last Name:WARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-876-7457
Mailing Address - Street 1:1269 E ROCK SPRINGS RD NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30306-2266
Mailing Address - Country:US
Mailing Address - Phone:404-876-7457
Mailing Address - Fax:
Practice Address - Street 1:1645 TULLIE CIR NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30329-2304
Practice Address - Country:US
Practice Address - Phone:404-785-7141
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA45360146D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes146D00000XEmergency Medical Service ProvidersPersonal Emergency Response AttendantGroup - Single Specialty