Individual
MS. ANDREA M DELOACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
711 KNIGHT AVE, WAYCROSS, GA 31501-1943
(912) 283-9423
(912) 283-2946
Mailing address
711 KNIGHT AVE, WAYCROSS, GA 31501-1943
(912) 283-9423
(912) 283-2946
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
RN072616
GA
363LW0102X
Women's Health Nurse Practitioner
RN072616
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00560381B
—
GA
01
—
1114007044
MEDICARE NPI
GA
01
—
CG6045
RAILROAD MEDICARE GROUP ID
GA
Enumeration date
10/16/2006
Last updated
06/11/2021
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