MEDICARE: DELTA OBSTETRICS & GYNECOLOGY, P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207VX0000X	Obstetrics Physician		MS

General Provider Information

NPI Number	:	1083827315
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DELTA OBSTETRICS & GYNECOLOGY, P.A.

Provider Business Mailing Address
First Line	:	801 1ST ST
Second Line	:
City	:	CLEVELAND
State	:	MS
Zip	:	38732-2309
Country	:	US
Telephone Number	:	662-843-0880
Fax Number	:	662-843-0886

Provider Business Practice Location Address
First Line	:	801 1ST ST
Second Line	:
City	:	CLEVELAND
State	:	MS
Zip	:	38732-2309
Country	:	US
Telephone Number	:	662-843-0880
Fax Number	:	662-843-0886

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MS. LEE B TEDFORD
Credential	:
Telephone Number	:	662-843-0880

Provider Enumeration Date	:	05/07/2007
Last Update Date	:	07/06/2010

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