Healthcare Provider Details

I. General information

NPI: 1548260144
Provider Name (Legal Business Name): DEKALB COMMUNITY SERVICE BOARD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3807 CLAIRMONT RD
CHAMBLEE GA
30341-4911
US

IV. Provider business mailing address

3807 CLAIRMONT RD
CHAMBLEE GA
30341-4911
US

V. Phone/Fax

Practice location:
  • Phone: 770-457-6236
  • Fax:
Mailing address:
  • Phone: 770-457-6236
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number007051
License Number StateGA

VIII. Authorized Official

Name: GARY S RICHEY
Title or Position: DIRECTOR
Credential: MBA
Phone: 404-294-3836