Basic Information
Provider Information
NPI: 1174557110
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: DELANEY
FirstName: SEAN
MiddleName: EUGEN
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 665 DULUTH HWY STE 801
Address2:  
City: LAWRENCEVILLE
State: GA
PostalCode: 300468709
CountryCode: US
TelephoneNumber: 4703250148
FaxNumber: 7703390485
Practice Location
Address1: 755 WALTHER RD
Address2:  
City: LAWRENCEVILLE
State: GA
PostalCode: 30046
CountryCode: US
TelephoneNumber: 7709624895
FaxNumber:  
Other Information
ProviderEnumerationDate: 07/10/2006
LastUpdateDate: 09/24/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 09/24/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RC0000XG49001GAN Allopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
207RI0011X49001GAY Allopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology

No ID Information.


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