MEDICARE: GINA M DELGARDO PH.D.

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	103G00000X	Clinical Neuropsychologist	2893	TN
2	103TC0700X	Clinical Psychologist	2893	TN
3	103TH0100X	Health Service Psychologist	2893	TN
4	103TF0200X	Forensic Psychologist	2893	TN
5	103TR0400X	Rehabilitation Psychologist	2893	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2893	OTHER	TN	LICENSURE

General Provider Information

NPI Number	:	1902028160
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GINA M DELGARDO PH.D.

Provider Business Mailing Address
First Line	:	PO BOX 4896
Second Line	:
City	:	CHATTANOOGA
State	:	TN
Zip	:	37405-0896
Country	:	US
Telephone Number	:	423-427-6822
Fax Number	:	423-301-8985

Provider Business Practice Location Address
First Line	:	200 W MARTIN LUTHER KING BLVD STE 1000
Second Line	:
City	:	CHATTANOOGA
State	:	TN
Zip	:	37402-2571
Country	:	US
Telephone Number	:	423-427-6822
Fax Number	:	423-301-8985

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

Provider Enumeration Date	:	05/03/2007
Last Update Date	:	01/06/2026

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