Organization
SOUTH DEKALB PRIMARY CARE, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISA WELCH MD (DIRECT OWNER)
(404) 289-1952
Entity
Organization
Contact information
Practice address
1290 COLUMBIA DR, DECATUR, GA 30032-2824
(404) 289-1952
(404) 289-1953
Mailing address
1290 COLUMBIA DR, DECATUR, GA 30032-2824
(404) 289-1952
(404) 289-1953
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
156445
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
156445
BUSINESS LICENSE
GA
Enumeration date
03/22/2007
Last updated
11/25/2015
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