Healthcare Provider Details

I. General information

NPI: 1417136920
Provider Name (Legal Business Name): CHRISTOPHER BRIAN DELASHMITT D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2007
Last Update Date: 03/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 MEMORIAL DR HOSPITALIST DEPARTMENT
DALTON GA
30720-2529
US

IV. Provider business mailing address

1200 MEMORIAL DR HOSPITALIST DEPARTMENT
DALTON GA
30720-2529
US

V. Phone/Fax

Practice location:
  • Phone: 706-272-6876
  • Fax:
Mailing address:
  • Phone: 706-272-6876
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number64023
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: