Healthcare Provider Details

I. General information

NPI: 1104891316
Provider Name (Legal Business Name): JACINTO DEL MAZO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2006
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 PEACHTREE ST NE SUITE 1600
ATLANTA GA
30308
US

IV. Provider business mailing address

550 PEACHTREE ST NE STE 1700
ATLANTA GA
30308-2262
US

V. Phone/Fax

Practice location:
  • Phone: 404-881-1094
  • Fax: 404-874-1249
Mailing address:
  • Phone: 404-881-9727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number14238
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number14238
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: