Healthcare Provider Details

I. General information

NPI: 1104937861
Provider Name (Legal Business Name): JOHN DELGAUDIO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 03/17/2023
Certification Date: 03/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1365A CLIFTON RD NE DEPARTMENT OF OTOLARYNGOLOGY
ATLANTA GA
30322-1013
US

IV. Provider business mailing address

1365A CLIFTON RD NE DEPARTMENT OF OTOLARYNGOLOGY
ATLANTA GA
30322-1013
US

V. Phone/Fax

Practice location:
  • Phone: 404-778-8331
  • Fax: 404-778-4295
Mailing address:
  • Phone: 404-778-8331
  • Fax: 404-778-4295

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number39772
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207YX0602X
TaxonomyOtolaryngic Allergy Physician
License Number39772
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: