Individual
KEVIN C DELLSPERGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1120 15TH STREET, AUGUSTA, GA 30912-0004
(706) 724-6100
Mailing address
1499 WALTON WAY, SUITE 1400, AUGUSTA, GA 30901-2602
(706) 724-6100
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
071064
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003141162B
—
GA
01
—
GA1581
MEDICAID
SC
Enumeration date
05/13/2006
Last updated
12/11/2015
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