Provider Demographics
NPI:1750488052
Name:DEKALB COUNTY BOARD OF HEALTH
Entity Type:Organization
Organization Name:DEKALB COUNTY BOARD OF HEALTH
Other - Org Name:EAST TEEN CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:DISTRICT DIRECTOR/CEO
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:E
Authorized Official - Last Name:BOUCHELION
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-294-3787
Mailing Address - Street 1:445 WINN WAY
Mailing Address - Street 2:PO BOX 987
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-1707
Mailing Address - Country:US
Mailing Address - Phone:404-294-3701
Mailing Address - Fax:404-508-7862
Practice Address - Street 1:2612 MAX CLELAND BLVD STE A
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30058-4400
Practice Address - Country:US
Practice Address - Phone:678-526-5429
Practice Address - Fax:678-526-5434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare