Provider Demographics
NPI:1598041741
Name:NETCARE MEDICAL CLINIC DECATUR, INC
Entity Type:Organization
Organization Name:NETCARE MEDICAL CLINIC DECATUR, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SOLOMON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-517-5012
Mailing Address - Street 1:4284 MEMORIAL DR STE C
Mailing Address - Street 2:SUITE C
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30032-1220
Mailing Address - Country:US
Mailing Address - Phone:404-592-2020
Mailing Address - Fax:404-592-1592
Practice Address - Street 1:4284 MEMORIAL DR STE C
Practice Address - Street 2:SUITE C
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30032-1220
Practice Address - Country:US
Practice Address - Phone:404-592-2020
Practice Address - Fax:404-592-1592
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-01
Last Update Date:2011-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's HealthGroup - Single Specialty