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Organization
CHOA HOSPITAL BASED, LLC
Active
Organization
CHOA HOSPITAL BASED, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RUTH FOWLER (CHIEF FINANCIAL OFFICER)
(404) 785-5437
Entity
Organization
Contact information
Practice address
1575 NORTHEAST EXPY NE, BROOKHAVEN, GA 30329-2401
(404) 785-6000
Mailing address
1575 NORTHEAST EXPY NE, BROOKHAVEN, GA 30329-2401
(404) 785-7876
Taxonomy
Speciality
Code
Description
License number
State
207LP3000X
Pediatric Anesthesiology Physician
—
—
207ZP0213X
Pediatric Pathology Physician
—
—
208000000X
Pediatrics Physician
Primary
—
—
2080N0001X
Neonatal-Perinatal Medicine Physician
—
—
2085P0229X
Pediatric Radiology Physician
—
—
363LN0000X
Neonatal Nurse Practitioner
—
—
363LP0200X
Pediatric Nurse Practitioner
—
—
367H00000X
Anesthesiologist Assistant
—
—
Other
Enumeration date
11/15/2012
Last updated
10/17/2025
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