Provider Demographics
NPI:1366671752
Name:DELP, MEREDITH (DO)
Entity Type:Individual
Prefix:
First Name:MEREDITH
Middle Name:
Last Name:DELP
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3240 AVALON PKWY
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30013-6320
Mailing Address - Country:US
Mailing Address - Phone:770-860-1133
Mailing Address - Fax:770-860-1599
Practice Address - Street 1:3240 AVALON PKWY
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30013-6320
Practice Address - Country:US
Practice Address - Phone:770-860-1133
Practice Address - Fax:770-860-1599
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-07
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALDO1180207V00000X
GA70083207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003136845BMedicaid