MEDICARE: DEKALB MEDICAL CENTER INC, DBA EMORY DECATUR HOSPITAL

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	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1295616845
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEKALB MEDICAL CENTER INC, DBA EMORY DECATUR HOSPITAL

Provider Business Mailing Address
First Line	:	2675 N DECATUR RD STE 101
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30033-6130
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2675 N DECATUR RD STE 101
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30033-6130
Country	:	US
Telephone Number	:	404-501-4680
Fax Number	:

Authorized Official
Title or Position	:	VP/CFO
Name	:	LISA URBISTONDO
Credential	:
Telephone Number	:	404-501-5025

Provider Enumeration Date	:	09/10/2025
Last Update Date	:	02/19/2026

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