Provider Demographics
NPI:1720285653
Name:THE EMORY CLINIC PEDIATRIC PROVIDERS
Entity Type:Organization
Organization Name:THE EMORY CLINIC PEDIATRIC PROVIDERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR SYSTEM CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:DOROTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:COOK WALTER
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MN, JD
Authorized Official - Phone:404-778-2144
Mailing Address - Street 1:1365 CLIFTON RD NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30322-1013
Mailing Address - Country:US
Mailing Address - Phone:404-778-2144
Mailing Address - Fax:404-778-4819
Practice Address - Street 1:101 W PONCE DE LEON AVE
Practice Address - Street 2:STE 300
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-2528
Practice Address - Country:US
Practice Address - Phone:404-778-2144
Practice Address - Fax:404-778-7466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207LP3000XAllopathic & Osteopathic PhysiciansAnesthesiologyPediatric AnesthesiologyGroup - Multi-Specialty
Not Answered207NP0225XAllopathic & Osteopathic PhysiciansDermatologyPediatric DermatologyGroup - Multi-Specialty
Not Answered207XP3100XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryPediatric Orthopaedic SurgeryGroup - Multi-Specialty
Not Answered207YP0228XAllopathic & Osteopathic PhysiciansOtolaryngologyPediatric OtolaryngologyGroup - Multi-Specialty
Not Answered207ZP0213XAllopathic & Osteopathic PhysiciansPathologyPediatric PathologyGroup - Multi-Specialty
Not Answered2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty
Not Answered2085P0229XAllopathic & Osteopathic PhysiciansRadiologyPediatric RadiologyGroup - Multi-Specialty
Not Answered2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric SurgeryGroup - Multi-Specialty