Healthcare Provider Details

I. General information

NPI: 1043239171
Provider Name (Legal Business Name): ROBERT J DELPOZO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 10/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2540 WINDY HILL RD SE
MARIETTA GA
30067-8605
US

IV. Provider business mailing address

301 AMBULANCE DR
CARROLLTON GA
30117-3865
US

V. Phone/Fax

Practice location:
  • Phone: 770-644-1570
  • Fax: 770-644-1576
Mailing address:
  • Phone: 770-836-9250
  • Fax: 770-836-9261

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number035853
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: