| East Dekalb | |
|
2277 Stone Mountain Lithonia Rd Lithonia GA 30058-5252 | |
| (770) 270-2710 | |
| (770) 270-2714 |
| Full Name | East Dekalb |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 2277 Stone Mountain Lithonia Rd, Lithonia, Georgia |
| Authorized Official Name and Position | Fabio Bruno Van Der Merwe (CEO) |
| Authorized Official Contact | 4042943836 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| East Dekalb 445 Winn Way Fl 4 Decatur GA 30030-1707 Ph: (404) 294-3836 | East Dekalb 2277 Stone Mountain Lithonia Rd Lithonia GA 30058-5252 Ph: (770) 270-2710 |
| NPI Number | 1447395488 |
|---|---|
| Provider Enumeration Date | 02/20/2007 |
| Last Update Date | 09/06/2023 |
| Certification Date | 09/06/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1447395488 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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