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DSH110076B DEKALB MEDICAL CENTER, INC - DBA EMORY DECATUR HOSPITAL (Active)
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Main Details
Name
DEKALB MEDICAL CENTER, INC - DBA EMORY DECATUR HOSPITAL
Subdivision Name
WOUND CARE CLINIC
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH110076B
Medicare Provider Number
110076
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/2/2015
Participating Start Date
1/1/2016
Participating Approval Date
10/6/2015
Last Recertification Date
8/23/2024
Contacts
Authorizing Official
Emory Decatur, Emory Hillandale
Lisa Urbistondo, Vice President & CFO
(404) 501-5025
Primary Contact
Emory Healthcare
Sydney Kchao, Corporate Director of Pharmacy, Business Operations and Finance
(404) 686-2147
Addresses
Street Address
2665 NORTH DECATUR RD
SUITE 340
DECATUR, GA 30033-5918
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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April 2025
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