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NPI Code Detail

MEDICARE: DEKALB MEDICAL CENTER, INC.

MEDICARE: DEKALB MEDICAL CENTER, INC.
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
1282N00000XGeneral Acute Care Hospital044621GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1100191OTHERGABLUE CROSS BLUE SHIELD
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1962403865
Entity Type Code : Organization
Provider Name (Legal Business Name) : DEKALB MEDICAL CENTER, INC.
Provider Business Mailing Address
First Line : 2701 N DECATUR RD STE 1002B
Second Line :
City : DECATUR
State : GA
Zip : 30033-5918
Country : US
Telephone Number : 404-501-5025
Fax Number : 404-501-5627
Provider Business Practice Location Address
First Line : 2801 DEKALB MEDICAL PKWY
Second Line :
City : LITHONIA
State : GA
Zip : 30058-4996
Country : US
Telephone Number : 404-501-7534
Fax Number : 404-501-5811
Authorized Official
Title or Position : CORPORATE DIRECTOR
Name : CARLA D CASHIO
Credential :
Telephone Number : 404-686-1811
Provider Enumeration Date : 08/02/2005
Last Update Date : 04/03/2026

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