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General NPI Number Information
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NPI Number | 1548671936
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Entity Type | Organization
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Legal Business Name | DECATUR WELLNESS SERVICES, INC.
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Dates
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Enumeration Date | 05/19/2014
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Last Update Date | 05/19/2014
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Provider Practice Location Address
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Address Line | 235 E PONCE DE LEON AVE STE 308
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City | DECATUR
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State | GA
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Zip | 30030-3412
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Country | US
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Telephone | 404-371-8595
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Fax |
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Provider Business Mailing Address
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Address Line | 235 E PONCE DE LEON AVE STE 308
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City | DECATUR
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State | GA
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Zip | 30030-3412
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Country | US
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Telephone | 404-371-8595
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. KARI L DIANICH
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Credential | D.C.
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Telephone | 404-388-3996
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | CHIR005135
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License Number State | GA
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