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General NPI Number Information
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NPI Number | 1538586995
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Entity Type | Organization
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Legal Business Name | DEKALB GPO LLC
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Dates
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Enumeration Date | 03/24/2014
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Last Update Date | 03/24/2014
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Provider Practice Location Address
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Address Line | 2801 N DECATUR RD SUITE 200
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City | DECATUR
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State | GA
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Zip | 30033-5949
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Country | US
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Telephone | 404-296-5005
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Fax | 404-296-9417
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Provider Business Mailing Address
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Address Line | 2801 N DECATUR RD SUITE 200
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City | DECATUR
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State | GA
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Zip | 30033-5949
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Country | US
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Telephone | 404-296-5005
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Fax | 404-296-9417
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | BRIAN PALLONE
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Credential |
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Telephone | 404-296-5005
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number |
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License Number State |
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