1619014156 NPI number — CHILDREN'S HEALTHCARE OF ATLANTA AT HUGHES SPALDING

Table of content: (NPI 1619014156)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619014156 NPI number — CHILDREN'S HEALTHCARE OF ATLANTA AT HUGHES SPALDING

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHILDREN'S HEALTHCARE OF ATLANTA AT HUGHES SPALDING
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1619014156
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1584 TULLIE CIR NE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30329-2311
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
35 JESSE HILL JR DR SE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30303-3032
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-785-9980
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/01/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
THOMAS
Authorized Official First Name:
TOBY
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE PRESIDENT, MANAGED CARE
Authorized Official Telephone Number:
404-785-7914

Provider Taxonomy Codes

  • Taxonomy code: 282NC2000X , with the licence number:  060-514 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00679808 , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 012884300 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".