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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
2163WC0400XCase Management Registered NurseGA
3251X00000XSupports Brokerage AgencyGA
4261QF0400XFederally Qualified Health Center (FQHC)GA
5261QA0006XAmbulatory Fertility FacilityGA
6251K00000XPublic Health or Welfare Agency

General Provider Information

NPI Number : 1548366685
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 : 30 WARREN ST SE
Second Line :
City : ATLANTA
State : GA
Zip : 30317-2267
Country : US
Telephone Number : 404-370-7360
Fax Number : 404-370-7379
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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