Healthcare Provider Details

I. General information

NPI: 1881605152
Provider Name (Legal Business Name): REDEN C DELGADO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 10/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4900 IVEY RD NW STE 1301
ACWORTH GA
30101-4112
US

IV. Provider business mailing address

2293 ROME HWY
ROCKMART GA
30153-3577
US

V. Phone/Fax

Practice location:
  • Phone: 770-975-9077
  • Fax: 770-790-4964
Mailing address:
  • Phone: 770-684-0350
  • Fax: 770-684-0302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberRD087681
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number65957
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: