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DELTA PEDIATRICSLLC NPI 1154605749


NPI Information

NPI: 1154605749
Provider Name: DELTA PEDIATRICS,LLC
Classification: Pediatrics - 208000000X
Entity Type: Organization

CLIA Number: 11D2031384

Address:
3966 S BOGAN RD
BUILDING B
BUFORD, GA
ZIP 30519
Phone: (770) 713-4646
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DELTA PEDIATRICS,LLC is a pediatrics in Buford, GA. The provider is a pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. DELTA PEDIATRICS,LLC NPI is 1154605749. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

3966 S BOGAN RD
BUILDING B
BUFORD, GA
ZIP 30519-633
Phone: (770) 713-4646
Fax: (404) 201-2923

The provider's authorized official is Emmanuel E Mordi .
The authorized official title is Manager and has the following contact phone number (770) 713-4646.

The CLIA number assigned to this NPI record is 11D2031384 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 10/1/2011 and was last updated on 10/1/2011.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1208000000XPediatrics056894GEORGIAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1112742695EMEDICAIDGEORGIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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