Healthcare Provider Details

I. General information

NPI: 1114064540
Provider Name (Legal Business Name): KEVIN LEE DELLI-GATTI MD FAAP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 W GORDON ST
THOMASTON GA
30286
US

IV. Provider business mailing address

403 W GORDON ST
THOMASTON GA
30286
US

V. Phone/Fax

Practice location:
  • Phone: 706-647-1680
  • Fax: 706-646-3125
Mailing address:
  • Phone: 706-647-1680
  • Fax: 706-646-3125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number027529
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: