Provider Demographics
NPI:1558397455
Name:DELIMA, JUDITH D (MD)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:D
Last Name:DELIMA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 925
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:GA
Mailing Address - Zip Code:30655-0925
Mailing Address - Country:US
Mailing Address - Phone:770-267-2790
Mailing Address - Fax:770-207-0652
Practice Address - Street 1:333 ALCOVY ST
Practice Address - Street 2:SUITE 10
Practice Address - City:MONROE
Practice Address - State:GA
Practice Address - Zip Code:30655-2180
Practice Address - Country:US
Practice Address - Phone:770-267-2790
Practice Address - Fax:770-207-0652
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA028528208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA028528OtherGEORGIA STATE MEDICAL LICENSE
GA00326642AMedicaid
GA00326642AMedicaid