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General NPI Number Information
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NPI Number | 1821205824
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Entity Type | Organization
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Legal Business Name | JOHN A. DECLUE, D. O., P. C.
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Dates
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Enumeration Date | 05/17/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2024 6TH AVE
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City | COLUMBUS
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State | GA
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Zip | 31904-8911
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Country | US
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Telephone | 706-317-2170
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Fax | 706-317-2173
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Provider Business Mailing Address
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Address Line | PO BOX 4747
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City | COLUMBUS
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State | GA
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Zip | 31904-0747
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Country | US
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Telephone | 706-317-2170
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Fax | 706-317-2173
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Authorized Official
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Title or Position | PHYSICAN
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Name | DR. JOHN ANTHONY DECLUE
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Credential | D. O.
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Telephone | 706-317-2170
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 037522
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License Number State | GA
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