Provider Demographics
NPI:1578004453
Name:DELTA CLINICS, P.L.C.
Entity Type:Organization
Organization Name:DELTA CLINICS, P.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ELIE
Authorized Official - Middle Name:E
Authorized Official - Last Name:HAGE-KORBAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:731-512-0104
Mailing Address - Street 1:17 CENTRE PLAZA DRIVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305
Mailing Address - Country:US
Mailing Address - Phone:731-512-0104
Mailing Address - Fax:
Practice Address - Street 1:17 CENTRE PLAZA DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-2862
Practice Address - Country:US
Practice Address - Phone:731-512-0104
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-13
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000022418363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty