MEDICARE: EARL DELK NP

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	AC003643	MD
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	RN136294	GA
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	95018199	CA

General Provider Information

NPI Number	:	1356958060
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EARL DELK NP

Provider Business Mailing Address
First Line	:	3365 RIDGEROCK WAY
Second Line	:
City	:	SNELLVILLE
State	:	GA
Zip	:	30078-4176
Country	:	US
Telephone Number	:	678-602-2535
Fax Number	:

Provider Business Practice Location Address
First Line	:	3365 RIDGEROCK WAY
Second Line	:
City	:	SNELLVILLE
State	:	GA
Zip	:	30078-4176
Country	:	US
Telephone Number	:	678-602-2535
Fax Number	:

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

Provider Enumeration Date	:	09/26/2020
Last Update Date	:	03/09/2026

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