MEDICARE: DR. JACQUELINE DELASH DMD, MBA, MPH

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	1223G0001X	General Practice Dentistry	DN014990	GA
2	122300000X	Dentist	DN014990	GA

General Provider Information

NPI Number	:	1275916728
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JACQUELINE DELASH DMD, MBA, MPH

Provider Business Mailing Address
First Line	:	1235 ROBINSON RD STE H
Second Line	:
City	:	PEACHTREE CITY
State	:	GA
Zip	:	30269-3832
Country	:	US
Telephone Number	:	770-487-1880
Fax Number	:	770-487-1851

Provider Business Practice Location Address
First Line	:	1235 ROBINSON RD STE H
Second Line	:
City	:	PEACHTREE CITY
State	:	GA
Zip	:	30269-3832
Country	:	US
Telephone Number	:	770-487-1880
Fax Number	:	770-487-1851

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

Provider Enumeration Date	:	07/01/2015
Last Update Date	:	12/10/2025

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