Provider Demographics
NPI:1467771923
Name:CHILDREN'S HEALTHCARE OF ATLANTA
Entity Type:Organization
Organization Name:CHILDREN'S HEALTHCARE OF ATLANTA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:MIRIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSNER
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-SLP, ATP
Authorized Official - Phone:404-785-3763
Mailing Address - Street 1:5455 MERIDIAN MARKS RD NE STE 300
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-4722
Mailing Address - Country:US
Mailing Address - Phone:404-785-3763
Mailing Address - Fax:
Practice Address - Street 1:5455 MERIDIAN MARKS RD NE STE 300
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-4722
Practice Address - Country:US
Practice Address - Phone:404-785-3763
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-24
Last Update Date:2010-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA001276273Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit