Provider Demographics
NPI:1750787438
Name:DECATUR WEIGHTLOSS & PAIN CENTER LLC
Entity type:Organization
Organization Name:DECATUR WEIGHTLOSS & PAIN CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HARESH
Authorized Official - Middle Name:
Authorized Official - Last Name:MEHTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-254-2048
Mailing Address - Street 1:1685 CHURCH ST
Mailing Address - Street 2:SUITE 207
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-5901
Mailing Address - Country:US
Mailing Address - Phone:404-254-2048
Mailing Address - Fax:
Practice Address - Street 1:1685 CHURCH ST
Practice Address - Street 2:SUITE 207
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-5901
Practice Address - Country:US
Practice Address - Phone:404-254-2048
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-07
Last Update Date:2014-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty