Healthcare Provider Details

I. General information

NPI: 1659001857
Provider Name (Legal Business Name): KELLY MARIE DELGADO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2022
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

172 MJ TAYLOR RD
ADEL GA
31620-3497
US

IV. Provider business mailing address

172 MJ TAYLOR RD
ADEL GA
31620-3497
US

V. Phone/Fax

Practice location:
  • Phone: 229-896-8500
  • Fax:
Mailing address:
  • Phone: 229-896-8500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number111711
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: