Provider Demographics
NPI:1689320640
Name:DECKER FAMILY PRACTICE
Entity Type:Organization
Organization Name:DECKER FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:DECKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-213-0223
Mailing Address - Street 1:118 S BROAD ST
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:GA
Mailing Address - Zip Code:31006-5525
Mailing Address - Country:US
Mailing Address - Phone:478-213-0223
Mailing Address - Fax:
Practice Address - Street 1:18 S BROAD ST
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:GA
Practice Address - Zip Code:31006-5520
Practice Address - Country:US
Practice Address - Phone:478-837-7121
Practice Address - Fax:478-837-7020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-28
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty