MEDICARE: DR. DELON F.P. BRENNEN M.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	2080P0204X	Pediatric Emergency Medicine (Pediatrics) Physician	061826	GA
2	208000000X	Pediatrics Physician	061826	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1982653093
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DELON F.P. BRENNEN M.D.

Provider Business Mailing Address
First Line	:	720 WESTVIEW DR SW
Second Line	:	DEPARTMENT OF PEDIATRICS
City	:	ATLANTA
State	:	GA
Zip	:	30310-1458
Country	:	US
Telephone Number	:	404-756-1330
Fax Number	:

Provider Business Practice Location Address
First Line	:	720 WESTVIEW DR SW
Second Line	:	DEPARTMENT OF PEDIATRICS
City	:	ATLANTA
State	:	GA
Zip	:	30310-1458
Country	:	US
Telephone Number	:	404-756-1330
Fax Number	:

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

Provider Enumeration Date	:	05/08/2006
Last Update Date	:	05/07/2009

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