Provider Demographics
NPI:1831650183
Name:DELEVEAUX, ANQUILLA V (MD)
Entity Type:Individual
Prefix:
First Name:ANQUILLA
Middle Name:V
Last Name:DELEVEAUX
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 1:3333 JODECO RD STE D
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-5371
Mailing Address - Country:US
Mailing Address - Phone:770-474-1919
Mailing Address - Fax:770-474-7832
Practice Address - Street 1:3333 JODECO RD STE D
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-5371
Practice Address - Country:US
Practice Address - Phone:770-474-1919
Practice Address - Fax:770-474-7832
Is Sole Proprietor?:No
Enumeration Date:2019-03-28
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA96726207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology