MEDICARE: MR. DAVID H DECKNER-GLICK MSW, LCSW

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	1041C0700X	Clinical Social Worker	CSW002732	GA

General Provider Information

NPI Number	:	1750328977
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DAVID H DECKNER-GLICK MSW, LCSW

Provider Business Mailing Address
First Line	:	707 WHITLOCK AVE SW STE G6
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30064-4653
Country	:	US
Telephone Number	:	770-331-8760
Fax Number	:	678-581-0146

Provider Business Practice Location Address
First Line	:	707 WHITLOCK AVE SW STE G6
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30064-4653
Country	:	US
Telephone Number	:	770-331-8760
Fax Number	:	770-977-3634

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2006
Last Update Date	:	05/31/2022

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