Healthcare Provider Details

I. General information

NPI: 1568857985
Provider Name (Legal Business Name): ADAM LUIS DELGADO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2015
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 E HOSPITAL RD. DEPARTMENT OF RADIOLOGY
FORT GORDON GA
30905
US

IV. Provider business mailing address

300 E HOSPITAL RD. DEPARTMENT OF RADIOLOGY
FORT GORDON GA
30905
US

V. Phone/Fax

Practice location:
  • Phone: 706-787-2161
  • Fax:
Mailing address:
  • Phone: 706-787-2161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number0101262517
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: