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Organization
CHILDREN'S HEALTHCARE OF ATLANTA AT SCOTTISH RITE
Active
Organization
CHILDREN'S HEALTHCARE OF ATLANTA AT SCOTTISH RITE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LOUETTA CODY (MANAGER, PROVIDER ENROLLMENT)
(404) 785-7876
Entity
Organization
Contact information
Practice address
5445 MERIDIAN MARKS RD NE, SUITE 200, ATLANTA, GA 30342-4763
(404) 785-3229
Mailing address
1584 TULLIE CIR NE, ATLANTA, GA 30329-2311
(404) 785-3229
Taxonomy
Speciality
Code
Description
License number
State
273Y00000X
Rehabilitation Hospital Unit
Primary
060-303
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000001636D
PEACH STATE PROVIDER ID
GA
05
—
000001636D
—
GA
01
—
10060840
AMERIGROUP PROVIDER ID
GA
01
—
325813
WELLCARE PROVIDER ID
GA
Enumeration date
11/15/2006
Last updated
03/24/2023
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