Provider Demographics
NPI:1881605152
Name:DELGADO, REDEN C (MD)
Entity type:Individual
Prefix:
First Name:REDEN
Middle Name:C
Last Name:DELGADO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2293 ROME HWY
Mailing Address - Street 2:
Mailing Address - City:ROCKMART
Mailing Address - State:GA
Mailing Address - Zip Code:30153-3577
Mailing Address - Country:US
Mailing Address - Phone:770-684-0350
Mailing Address - Fax:770-684-0302
Practice Address - Street 1:4900 IVEY RD NW STE 1301
Practice Address - Street 2:
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30101-4112
Practice Address - Country:US
Practice Address - Phone:770-975-9077
Practice Address - Fax:770-790-4964
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MIRD087681207Q00000X
GA65957207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIRD087681OtherSTATE LICENSE