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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