Provider Demographics
NPI:1902323876
Name:DECATUR HEALTH AND WELLNESS, LLC
Entity Type:Organization
Organization Name:DECATUR HEALTH AND WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSILAND
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-705-8695
Mailing Address - Street 1:1370 MONTREAL RD STE 112
Mailing Address - Street 2:
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-8128
Mailing Address - Country:US
Mailing Address - Phone:678-705-8695
Mailing Address - Fax:678-732-3395
Practice Address - Street 1:1370 MONTREAL RD STE 112
Practice Address - Street 2:
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-8128
Practice Address - Country:US
Practice Address - Phone:678-705-8695
Practice Address - Fax:678-732-3395
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-23
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA070255207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty