MEDICARE: JOHN A. DECLUE, D. O., P. C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	037522	GA

General Provider Information

NPI Number	:	1821205824
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHN A. DECLUE, D. O., P. C.

Provider Business Mailing Address
First Line	:	PO BOX 4747
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31904-0747
Country	:	US
Telephone Number	:	706-317-2170
Fax Number	:	706-317-2173

Provider Business Practice Location Address
First Line	:	2024 6TH AVE
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31904-8911
Country	:	US
Telephone Number	:	706-317-2170
Fax Number	:	706-317-2173

Authorized Official
Title or Position	:	PHYSICAN
Name	:	DR. JOHN ANTHONY DECLUE
Credential	:	D. O.
Telephone Number	:	706-317-2170

Provider Enumeration Date	:	05/17/2007
Last Update Date	:	08/22/2020

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