Provider Demographics
NPI:1558658526
Name:SOUTH DEKALB CENTER FOR HEALTHY LIVING
Entity Type:Organization
Organization Name:SOUTH DEKALB CENTER FOR HEALTHY LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:RANSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-484-2777
Mailing Address - Street 1:2699 KLONDIKE RD
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30058-4573
Mailing Address - Country:US
Mailing Address - Phone:770-484-2777
Mailing Address - Fax:770-808-3958
Practice Address - Street 1:2699 KLONDIKE RD
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30058-4573
Practice Address - Country:US
Practice Address - Phone:770-484-2777
Practice Address - Fax:770-808-3958
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-29
Last Update Date:2011-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Multi-Specialty