Organization
CHILDREN'S CLINIC OF ATLANTA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. NINA BRAZELL BASS M.D. (OWNER)
(404) 814-0733
Entity
Organization
Contact information
Practice address
2967 A GRANDVIEW AVE NE, ATLANTA, GA 30305
(404) 814-0733
(404) 814-0584
Mailing address
PO BOX 11989, ATLANTA, GA 30355-1989
(404) 814-0733
(404) 814-0584
Taxonomy
Speciality
Code
Description
License number
State
302F00000X
Exclusive Provider Organization
Primary
031559
GA
Other
Enumeration date
02/11/2008
Last updated
02/11/2008
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