Children's Clinic of Atlanta

Primary specialty

Exclusive Provider OrganizationTaxonomy code 302F00000X

License

031559 Issued in GA

Legal business name

CHILDREN'S CLINIC OF ATLANTA

Practice address

2967 A Grandview Ave NE
Atlanta, GA 30305

Phone

(404) 814-0733

Fax

(404) 814-0584

NPI assigned

Feb 11, 2008

Last updated

Feb 11, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Nina Brazell Bass, M.D.NPI 1548481005

Title

Owner

Phone

(404) 814-0733

Specialties & licenses 1

Addresses

Practitioners 1

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.

• Nina Brazell Bass, M.D.

  • Child & Adolescent Psychiatry Physician
  • Atlanta, GA
  • NPI 1548481005
  NPD (past) Authorized official

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

{
    "created_epoch": "1202688000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1202688000000",
    "number": "1780852921",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 11989",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303551989",
            "telephone_number": "404-814-0733",
            "fax_number": "404-814-0584"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2967 A GRANDVIEW AVE NE",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "30305",
            "telephone_number": "404-814-0733",
            "fax_number": "404-814-0584"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHILDREN'S CLINIC OF ATLANTA",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-11",
        "last_updated": "2008-02-11",
        "status": "A",
        "authorized_official_last_name": "BASS",
        "authorized_official_first_name": "NINA",
        "authorized_official_middle_name": "BRAZELL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "404-814-0733",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "302F00000X",
            "taxonomy_group": "",
            "desc": "Exclusive Provider Organization",
            "state": "GA",
            "license": "031559",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Exclusive Provider Organization in Atlanta, GA
• Providers in Atlanta, GA by specialty
• Exclusive Provider Organization in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.