Healthcare Provider Details

I. General information

NPI: 1275845893
Provider Name (Legal Business Name): DEKALB WOMEN'S SPECIALISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2010
Last Update Date: 07/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8052 MALL PKWY SUITE 202
LITHONIA GA
30038-2649
US

IV. Provider business mailing address

8052 MALL PKWY SUITE 202
LITHONIA GA
30038-2649
US

V. Phone/Fax

Practice location:
  • Phone: 404-508-5012
  • Fax: 770-484-1900
Mailing address:
  • Phone: 404-508-5012
  • Fax: 770-484-1900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number032293
License Number StateGA

VIII. Authorized Official

Name: DR. ALBERT SCOTT JR.
Title or Position: C.E.O.
Credential: M.D.
Phone: 404-508-5014