# THE EMORY CLINIC PEDIATRIC PROVIDERS

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1720285653
- **Authorized official:** DOROTHY COOK WALTER RN, MN, JD (DIRECTOR SYSTEM CREDENTIALING)
- **Authorized official phone:** (404) 778-2144

## Contact information

- **Practice address:** 101 W PONCE DE LEON AVE, STE 300, DECATUR, GA 30030-2528
- **Practice address phone:** (404) 778-2144
- **Practice address fax:** (404) 778-7466
- **Mailing address:** 1365 CLIFTON RD NE, ATLANTA, GA 30322-1013
- **Mailing address phone:** (404) 778-2144
- **Mailing address fax:** (404) 778-4819

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207LP3000X | Pediatric Anesthesiology Physician | — | NULL | — |
| 207LP3000X | Pediatric Anesthesiology Physician | — | — | — |
| 207NP0225X | Pediatric Dermatology Physician | — | NULL | — |
| 207NP0225X | Pediatric Dermatology Physician | — | — | — |
| 207XP3100X | Pediatric Orthopaedic Surgery Physician | — | NULL | — |
| 207XP3100X | Pediatric Orthopaedic Surgery Physician | — | — | — |
| 207YP0228X | Pediatric Otolaryngology Physician | — | NULL | — |
| 207YP0228X | Pediatric Otolaryngology Physician | — | — | — |
| 207ZP0213X | Pediatric Pathology Physician | — | NULL | — |
| 207ZP0213X | Pediatric Pathology Physician | — | — | — |
| 2084P0804X | Child & Adolescent Psychiatry Physician | — | NULL | — |
| 2084P0804X | Child & Adolescent Psychiatry Physician | — | — | — |
| 2085P0229X | Pediatric Radiology Physician | — | NULL | — |
| 2085P0229X | Pediatric Radiology Physician | — | — | — |
| 2086S0120X | Pediatric Surgery Physician | — | NULL | Yes |
| 2086S0120X | Pediatric Surgery Physician | — | — | Yes |

## Other

- **Enumeration date:** 07/03/2007
- **Last updated:** 09/11/2025