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NPI Code Detail

MEDICARE: DEKALB COMMUNITY SERVICE BOARD

MEDICARE: DEKALB COMMUNITY SERVICE BOARD
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
1183500000XPharmacist007051GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
21136654OTHERGANCPDP/NABP PROVIDER NUMBE

General Provider Information

NPI Number : 1548260144
Entity Type Code : Organization
Provider Name (Legal Business Name) : DEKALB COMMUNITY SERVICE BOARD
Provider Business Mailing Address
First Line : 3807 CLAIRMONT RD
Second Line :
City : CHAMBLEE
State : GA
Zip : 30341-4911
Country : US
Telephone Number : 770-457-6236
Fax Number :
Provider Business Practice Location Address
First Line : 3807 CLAIRMONT RD
Second Line :
City : CHAMBLEE
State : GA
Zip : 30341-4911
Country : US
Telephone Number : 770-457-6236
Fax Number :
Authorized Official
Title or Position : DIRECTOR
Name : GARY S RICHEY
Credential : MBA
Telephone Number : 404-294-3836
Provider Enumeration Date : 07/26/2005
Last Update Date : 08/22/2020

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Directions to “DEKALB COMMUNITY SERVICE BOARD ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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