Individual
MADELEINE DELPORTILLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2701 NORTH DECATUR RD, DECATUR, GA 30034
(404) 501-1843
(404) 501-1837
Mailing address
2247 SALIENT RD, MARIETTA, GA 30064
(404) 501-1843
(404) 501-1837
Taxonomy
Speciality
Code
Description
License number
State
2080N0001X
Neonatal-Perinatal Medicine Physician
Primary
021672
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000244703AG
—
GA
05
—
000244703AH
—
GA
01
—
06581141
AMERIGROUP
GA
Enumeration date
10/31/2006
Last updated
02/14/2019
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