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General NPI Number Information
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NPI Number | 1174609390
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Entity Type | Individual
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Provider Name | MADELEINE DELPORTILLO MD
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Gender | Female
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Dates
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Enumeration Date | 10/31/2006
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Last Update Date | 02/14/2019
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Provider Practice Location Address
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Address Line | 2701 NORTH DECATUR RD
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City | DECATUR
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State | GA
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Zip | 30034
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Country | US
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Telephone | 404-501-1843
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Fax | 404-501-1837
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Provider Business Mailing Address
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Address Line | 2247 SALIENT RD
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City | MARIETTA
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State | GA
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Zip | 30064
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Country | US
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Telephone | 404-501-1843
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Fax | 404-501-1837
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080N0001X
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Taxonomy Name | Neonatal-Perinatal Medicine Physician
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License Number | 021672
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License Number State | GA
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