Provider Demographics
NPI:1851604995
Name:DEKALB WOMEN'S SPECIALISTS
Entity Type:Organization
Organization Name:DEKALB WOMEN'S SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LEAD PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:404-508-2000
Mailing Address - Street 1:2675 N DECATUR RD
Mailing Address - Street 2:SUITE 512
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-6131
Mailing Address - Country:US
Mailing Address - Phone:404-508-2000
Mailing Address - Fax:
Practice Address - Street 1:5295 STONE MOUNTAIN HWY
Practice Address - Street 2:SUITE N
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30087-6416
Practice Address - Country:US
Practice Address - Phone:404-508-2000
Practice Address - Fax:770-469-1009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-19
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA032293207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP632Medicare UPIN