| Organization Name: | DEKALB MEDICAL PRIMARY CARE GROUP LLC |
| NPI Number: | 1104077171 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DUANE BARCLAY (ADMINISTRATOR) |
| Mailing Address: | 2701 N Decatur Rd Decatur |
| State: | GA US |
| Postal Code: | 300335918 |
| Phone Number: | 4045013870 |
| Fax Number: | |
| NPI Enumeration Date: | 10/08/2008 |
| NPI Last Update Date: | 10/21/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |