Provider Demographics
NPI:1578011722
Name:DEKLE, TAMEKA
Entity Type:Individual
Prefix:
First Name:TAMEKA
Middle Name:
Last Name:DEKLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 WINDY HILL PT
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-4493
Mailing Address - Country:US
Mailing Address - Phone:470-274-6470
Mailing Address - Fax:
Practice Address - Street 1:602 WINDY HILL PT
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-4493
Practice Address - Country:US
Practice Address - Phone:470-274-6470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-16
Last Update Date:2016-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACN0028840721376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide