Provider Demographics
NPI:1063463750
Name:DELLACONA, SALVATORE JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:SALVATORE
Middle Name:JOHN
Last Name:DELLACONA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1700 SPRINGHILL CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:LIZELLA
Mailing Address - State:GA
Mailing Address - Zip Code:31052
Mailing Address - Country:US
Mailing Address - Phone:478-335-4862
Mailing Address - Fax:478-477-9098
Practice Address - Street 1:1700 SPRINGHILL CHURCH RD
Practice Address - Street 2:
Practice Address - City:LIZELLA
Practice Address - State:GA
Practice Address - Zip Code:31052
Practice Address - Country:US
Practice Address - Phone:478-335-4862
Practice Address - Fax:478-477-9098
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-15
Last Update Date:2018-09-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA034329207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
B13137Medicare UPIN