MEDICARE: DR. DELIA RADOVICH MD

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	207R00000X	Internal Medicine Physician	25MA07772400	NJ
2	207RX0202X	Medical Oncology Physician	93950	GA
3	207RH0003X	Hematology & Oncology Physician	25MA07772400	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	93950	OTHER	GA	STATE LICENSE

General Provider Information

NPI Number	:	1255311437
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DELIA RADOVICH MD

Provider Business Mailing Address
First Line	:	600 CELEBRATE LIFE PKWY
Second Line	:
City	:	NEWNAN
State	:	GA
Zip	:	30265-8001
Country	:	US
Telephone Number	:	770-400-6000
Fax Number	:

Provider Business Practice Location Address
First Line	:	600 CELEBRATE LIFE PKWY
Second Line	:
City	:	NEWNAN
State	:	GA
Zip	:	30265-8001
Country	:	US
Telephone Number	:	770-400-6000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/23/2006
Last Update Date	:	04/08/2024

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Directions to “ DR. DELIA RADOVICH MD” Practice Location

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