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General NPI Number Information
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NPI Number | 1902323876
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Entity Type | Organization
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Legal Business Name | DECATUR HEALTH AND WELLNESS, LLC
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Dates
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Enumeration Date | 08/23/2017
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Last Update Date | 03/09/2023
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Provider Practice Location Address
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Address Line | 1370 MONTREAL RD STE 112
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City | TUCKER
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State | GA
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Zip | 30084-8128
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Country | US
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Telephone | 678-705-8695
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Fax | 678-732-3395
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Provider Business Mailing Address
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Address Line | 1370 MONTREAL RD STE 112
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City | TUCKER
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State | GA
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Zip | 30084-8128
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Country | US
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Telephone | 678-705-8695
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Fax | 678-732-3395
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Authorized Official
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Title or Position | MANAGING PHYSICIAN
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Name | DR. ROSILAND HARRINGTON
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Credential | MD
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Telephone | 678-705-8695
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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 | 070255
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License Number State | GA
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