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Organization

CARDIOTHORACIC PROVIDERS AT CHILDREN'S, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
RUTH FOWLER (CHIEF FINANCIAL OFFICER)
(404) 785-5437
Entity
Organization

Contact information

Practice address
1575 NORTHEAST EXPY NE, BROOKHAVEN, GA 30329-2401
(404) 785-5437
Mailing address
1575 NORTHEAST EXPY NE, BROOKHAVEN, GA 30329-2401

Taxonomy

Speciality
Code
Description
License number
State
2086S0120X
Pediatric Surgery Physician
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary

Other

Enumeration date
01/11/2016
Last updated
10/17/2025
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