Basic Information
Provider Information
NPI: 1962027037
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: DELMONICO
FirstName: ADRIANA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 59 ROUND ROCK CIR NE
Address2:  
City: ROME
State: GA
PostalCode: 301619328
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 304 TURNER MCCALL BLVD SW
Address2:  
City: ROME
State: GA
PostalCode: 301655621
CountryCode: US
TelephoneNumber: 7065095000
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/14/2020
LastUpdateDate: 06/14/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 06/14/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
390200000X  Y Student, Health CareStudent in an Organized Health Care Education/Training Program 

No ID Information.


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