Organization
WINDER SURGICAL SPECIALIST
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CESAR MEDALLA DELIMA M.D. (PROVIDER)
(770) 307-1305
Entity
Organization
Contact information
Practice address
314 N BROAD ST, SUITE 350, WINDER, GA 30680-2191
(770) 307-1305
(770) 307-1522
Mailing address
PO BOX 1169, WINDER, GA 30680-1169
(770) 307-1305
(770) 307-1522
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
028396
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000324244D
—
GA
01
—
52238010
BLUE CROSS BLUE SHIELD
GA
Enumeration date
05/01/2008
Last updated
06/04/2008
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