Healthcare Provider Details

I. General information

NPI: 1396807798
Provider Name (Legal Business Name): DEL MAZO MEDICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 11/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 PEACHTREE ST NE SUITE 1035
ATLANTA GA
30308-2221
US

IV. Provider business mailing address

550 PEACHTREE ST NE SUITE 1035
ATLANTA GA
30308-2221
US

V. Phone/Fax

Practice location:
  • Phone: 404-577-1112
  • Fax: 404-557-1543
Mailing address:
  • Phone: 404-577-1112
  • Fax: 404-577-1543

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number014238
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number036741
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number025728
License Number StateGA

VIII. Authorized Official

Name: ARLENE DEL MAZO
Title or Position: ADMINISTRATOR
Credential: R.N.
Phone: 404-880-4201