Provider Demographics
NPI:1275845893
Name:DEKALB WOMEN'S SPECIALISTS
Entity Type:Organization
Organization Name:DEKALB WOMEN'S SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:DR
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:404-508-5014
Mailing Address - Street 1:8052 MALL PKWY
Mailing Address - Street 2:SUITE 202
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30038-2649
Mailing Address - Country:US
Mailing Address - Phone:404-508-5012
Mailing Address - Fax:770-484-1900
Practice Address - Street 1:8052 MALL PKWY
Practice Address - Street 2:SUITE 202
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30038-2649
Practice Address - Country:US
Practice Address - Phone:404-508-5012
Practice Address - Fax:770-484-1900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-12
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA032293207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP632Medicare PIN