# CLINICA MEDICA DR RENE DELGADO, INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** CLINICA MEDICA FAMILIAR
- **Organization subpart:** No

## Provider details

- **NPI number:** 1639319254
- **Authorized official:** JACK DOURRON (PRACTICE MANAGER)
- **Authorized official phone:** (770) 996-9681

## Contact information

- **Practice address:** 189 MEDICAL WAY, SUITE B, RIVERDALE, GA 30274-4905
- **Practice address phone:** (770) 996-9681
- **Practice address fax:** (770) 996-9683
- **Mailing address:** 189 MEDICAL WAY, SUITE B, RIVERDALE, GA 30274-4905
- **Mailing address phone:** (770) 996-9681
- **Mailing address fax:** (770) 996-9683

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 027722 | GA | — |
| 207V00000X | Obstetrics & Gynecology Physician | 014308 | GA | Yes |

## Other

- **Enumeration date:** 02/22/2009
- **Last updated:** 02/22/2009