# CHILDREN'S CLINIC OF ATLANTA

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

## Provider details

- **NPI number:** 1780852921
- **Authorized official:** DR. NINA BRAZELL BASS M.D. (OWNER)
- **Authorized official phone:** (404) 814-0733

## Contact information

- **Practice address:** 2967 A GRANDVIEW AVE NE, ATLANTA, GA 30305
- **Practice address phone:** (404) 814-0733
- **Practice address fax:** (404) 814-0584
- **Mailing address:** PO BOX 11989, ATLANTA, GA 30355-1989
- **Mailing address phone:** (404) 814-0733
- **Mailing address fax:** (404) 814-0584

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 302F00000X | Exclusive Provider Organization | 031559 | GA | Yes |

## Other

- **Enumeration date:** 02/11/2008
- **Last updated:** 02/11/2008