Healthcare Provider Details

I. General information

NPI: 1225085475
Provider Name (Legal Business Name): DEKALB WOMEN'S SPECIALISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2006
Last Update Date: 10/15/2021
Certification Date: 10/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1458 CHURCH ST STE B
DECATUR GA
30030-1672
US

IV. Provider business mailing address

1458 CHURCH ST STE B
DECATUR GA
30030-1672
US

V. Phone/Fax

Practice location:
  • Phone: 404-508-2000
  • Fax: 404-508-5560
Mailing address:
  • Phone: 404-508-5012
  • Fax: 404-508-5560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number StateGA

VIII. Authorized Official

Name: SABRINA SCOTT
Title or Position: PRACTICE LIAISON
Credential: ESQ
Phone: 404-376-4155