Healthcare Provider Details

I. General information

NPI: 1720085012
Provider Name (Legal Business Name): GWENDOLYN A DELANEY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2005
Last Update Date: 01/14/2020
Certification Date: 01/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 PEACHTREE PKWY STE 4260
CUMMING GA
30041-7407
US

IV. Provider business mailing address

4914 HIGHWAY 9 N
ALPHARETTA GA
30004-2921
US

V. Phone/Fax

Practice location:
  • Phone: 678-990-2501
  • Fax: 678-990-2505
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number049380
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: