Provider Demographics
NPI:1205981974
Name:LAWRENCE JOEL ARMY HEALTH CLINIC
Entity type:Organization
Organization Name:LAWRENCE JOEL ARMY HEALTH CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERNAL MEDICINE PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:MELIDA
Authorized Official - Middle Name:E
Authorized Official - Last Name:DELERME
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-464-0405
Mailing Address - Street 1:233 PLANTATION DR
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30296-1137
Mailing Address - Country:US
Mailing Address - Phone:770-997-4607
Mailing Address - Fax:
Practice Address - Street 1:1701 HARDEE AVE S. W.
Practice Address - Street 2:FORT MCPHERSON
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30330
Practice Address - Country:US
Practice Address - Phone:404-464-0405
Practice Address - Fax:404-464-0475
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4326261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)