Provider Demographics
NPI:1548671936
Name:DECATUR WELLNESS SERVICES, INC.
Entity type:Organization
Organization Name:DECATUR WELLNESS SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KARI
Authorized Official - Middle Name:L
Authorized Official - Last Name:DIANICH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:404-388-3996
Mailing Address - Street 1:235 E PONCE DE LEON AVE STE 308
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-3412
Mailing Address - Country:US
Mailing Address - Phone:404-371-8595
Mailing Address - Fax:
Practice Address - Street 1:235 E PONCE DE LEON AVE STE 308
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-3412
Practice Address - Country:US
Practice Address - Phone:404-371-8595
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-19
Last Update Date:2014-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR005135261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care