Provider Demographics
NPI:1619437035
Name:DELIWALA, SMIT SUNIL (MD)
Entity Type:Individual
Prefix:
First Name:SMIT
Middle Name:SUNIL
Last Name:DELIWALA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 MICHAEL ST NE STE 201
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30322-1047
Mailing Address - Country:US
Mailing Address - Phone:404-727-5596
Mailing Address - Fax:404-727-5767
Practice Address - Street 1:615 MICHAEL ST NE STE 201
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322-5902
Practice Address - Country:US
Practice Address - Phone:404-727-5596
Practice Address - Fax:404-727-5767
Is Sole Proprietor?:No
Enumeration Date:2019-03-21
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI390200000X
GA14133390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program