NPIMap

Organization Active NPI

Cardiothoracic Providers at Children's, LLC

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Brookhaven, GA
National Provider Identifier
1558727289
Registry record updated Oct 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Thoracic Surgery (Cardiothoracic Vascular Surgery) PhysicianTaxonomy code 208G00000X
Legal business name
CARDIOTHORACIC PROVIDERS AT CHILDREN'S, LLC
Practice address
1575 Northeast Expy NE
Brookhaven, GA 30329-2401
Phone
(404) 785-5437
NPI assigned
Jan 11, 2016
Last updated
Oct 17, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 17, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ruth Fowler
Title
Chief Financial Officer
Phone
(404) 785-5437

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2086S0120X
Thoracic Surgery (Cardiothoracic Vascular Surgery) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208G00000X Primary

Addresses

Primary practice location

1575 Northeast Expy NE
Brookhaven, GA 30329-2401

Mailing address

1575 Northeast Expy NE
Brookhaven, GA 30329-2401

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20161014000965 GA Part B Supplier - Clinic/Group Practice 8123316734 Receives reassigned benefits from 11 practitioners
Practice locations: Atlanta, GA

National Provider Directory

National Provider Directory

Locations

Uppr Dr Ne
Atlanta, GA 30322

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1452470400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1760659200000",
    "number": "1558727289",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1575 NORTHEAST EXPY NE",
            "city": "BROOKHAVEN",
            "state": "GA",
            "postal_code": "303292401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1575 NORTHEAST EXPY NE",
            "city": "BROOKHAVEN",
            "state": "GA",
            "postal_code": "303292401",
            "telephone_number": "404-785-5437"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CARDIOTHORACIC PROVIDERS AT CHILDREN'S, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-01-11",
        "last_updated": "2025-10-17",
        "certification_date": "2025-10-17",
        "status": "A",
        "authorized_official_last_name": "FOWLER",
        "authorized_official_first_name": "RUTH",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "404-785-5437"
    },
    "taxonomies": [
        {
            "code": "2086S0120X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery, Pediatric Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208G00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brookhaven, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.