Healthcare Provider Details

I. General information

NPI: 1598041741
Provider Name (Legal Business Name): NETCARE MEDICAL CLINIC DECATUR, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2011
Last Update Date: 11/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4284 MEMORIAL DR STE C SUITE C
DECATUR GA
30032-1220
US

IV. Provider business mailing address

4284 MEMORIAL DR STE C SUITE C
DECATUR GA
30032-1220
US

V. Phone/Fax

Practice location:
  • Phone: 404-592-2020
  • Fax: 404-592-1592
Mailing address:
  • Phone: 404-592-2020
  • Fax: 404-592-1592

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL SOLOMON
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 314-517-5012