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Organization
MED-SURG PROVIDERS AT CHILDREN'S LLC
Active
Organization
MED-SURG PROVIDERS AT CHILDREN'S LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LOUETTA CODY (MGR, PROVIDER ENROLLMENT)
(404) 785-7876
Entity
Organization
Contact information
Practice address
1575 NORTHEAST EXPY NE, BROOKHAVEN, GA 30329-2401
(404) 785-7876
Mailing address
1575 NE EXPRESSWAY, BROOKHAVEN, GA 30329-2401
(404) 785-7876
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
—
—
208000000X
Pediatrics Physician
Primary
—
—
2080S0010X
Pediatric Sports Medicine Physician
—
—
2084P0804X
Child & Adolescent Psychiatry Physician
—
—
2086S0120X
Pediatric Surgery Physician
—
—
2086S0122X
Plastic and Reconstructive Surgery Physician
—
—
Other
Enumeration date
01/11/2016
Last updated
01/16/2025
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