Provider Demographics
NPI:1811026891
Name:DEKALB MEDICAL HOSPITALISTS LLC
Entity Type:Organization
Organization Name:DEKALB MEDICAL HOSPITALISTS LLC
Other - Org Name:DEKALB MEDICAL EMERGENCY ASSOCIATES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DIRECTOR EMR/QUALITY
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-501-7925
Mailing Address - Street 1:2701 N DECATUR RD
Mailing Address - Street 2:DEKALB MEDICAL PHYSICIANS GROUP
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-5918
Mailing Address - Country:US
Mailing Address - Phone:404-501-7925
Mailing Address - Fax:404-501-7473
Practice Address - Street 1:2701 N DECATUR RD
Practice Address - Street 2:DEKALB MEDICAL PHYSICIANS GROUP
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-5918
Practice Address - Country:US
Practice Address - Phone:404-501-7925
Practice Address - Fax:404-501-7473
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DEKALB MEDICAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-05
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP4108OtherMEDICARE GROUP NUMBER