Healthcare Provider Details

I. General information

NPI: 1083518849
Provider Name (Legal Business Name): GENIE MICHELLE DECKARD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2007 OLD LAFAYETTE RD
FORT OGLETHORPE GA
30742-3510
US

IV. Provider business mailing address

2007 OLD LAFAYETTE RD
FORT OGLETHORPE GA
30742-3510
US

V. Phone/Fax

Practice location:
  • Phone: 706-861-9390
  • Fax: 706-866-4740
Mailing address:
  • Phone: 706-861-9390
  • Fax: 706-866-4740

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License NumberCIT
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: