Healthcare Provider Details

I. General information

NPI: 1699713230
Provider Name (Legal Business Name): DELPHANIE DESHAN HEAD M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 01/13/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1175 CASCADE PKWY SW KAISER PERMANENTE CASCADE MEDICAL CENTER
ATLANTA GA
30311-3090
US

IV. Provider business mailing address

3495 PIEDMONT RD NE NINE PIEDMONT CENTER
ATLANTA GA
30305-1717
US

V. Phone/Fax

Practice location:
  • Phone: 404-505-4006
  • Fax: 404-524-8948
Mailing address:
  • Phone: 404-364-7070
  • Fax: 404-524-8948

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number047975
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: