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NPI Code Detail

MEDICARE: DEKALB COUNTY BOARD OF HEALTH

MEDICARE: DEKALB COUNTY BOARD OF HEALTH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251K00000XPublic Health or Welfare AgencyGA
2261QF0050XNon-Surgical Family Planning Clinic/CenterGA
3163WC0400XCase Management Registered Nurse
4261QF0400XFederally Qualified Health Center (FQHC)GA
5251X00000XSupports Brokerage AgencyGA
6251K00000XPublic Health or Welfare Agency

General Provider Information

NPI Number : 1053417105
Entity Type Code : Organization
Provider Name (Legal Business Name) : DEKALB COUNTY BOARD OF HEALTH
Provider Business Mailing Address
First Line : 445 WINN WAY
Second Line : PO BOX 987
City : DECATUR
State : GA
Zip : 30030-1707
Country : US
Telephone Number : 404-294-3701
Fax Number : 404-508-7862
Provider Business Practice Location Address
First Line : 3807 CLAIRMONT RD
Second Line :
City : CHAMBLEE
State : GA
Zip : 30341-4911
Country : US
Telephone Number : 770-454-1144
Fax Number : 770-452-4468
Authorized Official
Title or Position : DISTRICT DIRECTOR/CEO
Name : SANDRA E FORD
Credential : MD
Telephone Number : 404-294-3787
Provider Enumeration Date : 09/16/2006
Last Update Date : 10/23/2007

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Directions to “DEKALB COUNTY BOARD OF HEALTH ” Practice Location

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