Provider Demographics
NPI:1922056902
Name:MENDOZA, DELQUIS RAFAEL (MD)
Entity Type:Individual
Prefix:
First Name:DELQUIS
Middle Name:RAFAEL
Last Name:MENDOZA
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:P.O. BOX 370407
Mailing Address - Street 2:PATIENT ACCOUNTS OFFICE
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30034
Mailing Address - Country:US
Mailing Address - Phone:404-243-2100
Mailing Address - Fax:404-243-2159
Practice Address - Street 1:3073 PANTHERSVILLE ROAD
Practice Address - Street 2:PATIENTS ACCOUNTS OFFICE
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30034
Practice Address - Country:US
Practice Address - Phone:404-243-2100
Practice Address - Fax:404-243-2159
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0404362084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
26BDGVCMedicare ID - Type Unspecified
G13525Medicare UPIN