Healthcare Provider Details

I. General information

NPI: 1821099474
Provider Name (Legal Business Name): DEKALB MEDICAL PSYCH UNIT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2005
Last Update Date: 02/22/2024
Certification Date: 02/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 N DECATUR RD
DECATUR GA
30033-5918
US

IV. Provider business mailing address

2701 N DECATUR RD
DECATUR GA
30033-5918
US

V. Phone/Fax

Practice location:
  • Phone: 404-501-5185
  • Fax: 404-501-5811
Mailing address:
  • Phone: 404-501-1000
  • Fax: 404-501-5811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273R00000X
TaxonomyPsychiatric Hospital Unit
License Number044039
License Number StateGA

VIII. Authorized Official

Name: AVA E DAUNT-SAMFORD
Title or Position: VP/CFO
Credential:
Phone: 404-686-4918