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Organization
SCOTTISH RITE CHILDRENS MEDICAL CTR
Active
Organization
SCOTTISH RITE CHILDRENS MEDICAL CTR
Active
Other names
Children's Healthcare of Atlanta at Scottish Rite
Organization subpart
No
Provider details
NPI number
Authorized official
LOUETTA CODY (MGR, PROVIDER ENROLLMENT)
(404) 785-7876
Entity
Organization
Contact information
Practice address
1001 JOHNSON FERRY RD NE, ATLANTA, GA 30342-1605
(404) 785-5252
Mailing address
1575 NORTHEAST EXPY NE, BROOKHAVEN, GA 30329-2401
(404) 785-7876
Taxonomy
Speciality
Code
Description
License number
State
282NC2000X
Children's Hospital
Primary
060-303
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000001636A
PEACH STATE PROVIDER ID
GA
05
—
000001636A
—
GA
01
—
1000062
AMERIGROUP PROVIDER ID
GA
01
—
21316
WELLCARE PROVIDER ID
GA
Enumeration date
11/09/2006
Last updated
02/23/2023
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