Provider Demographics
NPI:1306819743
Name:DELGAUDIO-RIEMANN, STEPHANIE A (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:A
Last Name:DELGAUDIO-RIEMANN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:STEPHANIE
Other - Middle Name:A
Other - Last Name:RIEMANN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:4453 JETT RD NW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30327-3563
Mailing Address - Country:US
Mailing Address - Phone:404-257-3394
Mailing Address - Fax:
Practice Address - Street 1:980 WOODSTOCK PKWY
Practice Address - Street 2:SUITE 300
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-4870
Practice Address - Country:US
Practice Address - Phone:678-494-9545
Practice Address - Fax:678-494-9559
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-08
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA040362174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00772208BMedicaid
GAG66761Medicare UPIN
GA13BDDWPMedicare ID - Type Unspecified