MEDICARE: LAWRENCE JOEL ARMY HEALTH CLINIC

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
1	261QF0400X	Federally Qualified Health Center (FQHC)	4326	AL

General Provider Information

NPI Number	:	1205981974
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAWRENCE JOEL ARMY HEALTH CLINIC

Provider Business Mailing Address
First Line	:	233 PLANTATION DR
Second Line	:
City	:	RIVERDALE
State	:	GA
Zip	:	30296-1137
Country	:	US
Telephone Number	:	770-997-4607
Fax Number	:

Provider Business Practice Location Address
First Line	:	1701 HARDEE AVE S. W.
Second Line	:	FORT MCPHERSON
City	:	ATLANTA
State	:	GA
Zip	:	30330
Country	:	US
Telephone Number	:	404-464-0405
Fax Number	:	404-464-0475

Authorized Official
Title or Position	:	INTERNAL MEDICINE PROVIDER
Name	:	DR. MELIDA E. DELERME
Credential	:	M.D.
Telephone Number	:	404-464-0405

Provider Enumeration Date	:	01/24/2007
Last Update Date	:	08/22/2020

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