Provider Demographics
NPI:1962072801
Name:DECAMP, JACOB ALLAN (RPH)
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:ALLAN
Last Name:DECAMP
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:747 RALPH MCGILL BLVD NE UNIT 1259
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30312-1136
Mailing Address - Country:US
Mailing Address - Phone:678-865-7662
Mailing Address - Fax:
Practice Address - Street 1:3200 HOLCOMB BRIDGE RD
Practice Address - Street 2:
Practice Address - City:PEACHTREE CORNERS
Practice Address - State:GA
Practice Address - Zip Code:30092-3361
Practice Address - Country:US
Practice Address - Phone:770-417-5106
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-01
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH0329311835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist