| Dekalb Enterprises | |
|
4781 Lewis Rd Stone Mountain GA 30083-1020 | |
| (770) 270-2710 | |
| (770) 270-2714 |
| Full Name | Dekalb Enterprises |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 4781 Lewis Rd, Stone Mountain, Georgia |
| Authorized Official Name and Position | Fabio Bruno Van Der Merwe (COO) |
| Authorized Official Contact | 4042943836 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Dekalb Enterprises 445 Winn Way Fl 4 Decatur GA 30030-1707 Ph: (404) 294-3836 | Dekalb Enterprises 4781 Lewis Rd Stone Mountain GA 30083-1020 Ph: (770) 270-2710 |
| NPI Number | 1548304637 |
|---|---|
| Provider Enumeration Date | 02/20/2007 |
| Last Update Date | 04/28/2020 |
| Certification Date | 04/28/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548304637 | NPI | - | NPPES |
| 000599519E | Medicaid | GA | |
| 000603446J | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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