Individual
DR. DELORES IJEOMA IBETOH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3950 AUSTELL RD, AUSTELL, GA 30106-1121
(770) 732-4035
Mailing address
3950 AUSTELL RD, AUSTELL, GA 30106-1121
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
44903
TN
207R00000X
Internal Medicine Physician
Primary
66187
GA
208M00000X
Hospitalist Physician
66187
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1514545
—
TN
05
—
1514660
—
TN
05
—
1861613945
—
VA
Enumeration date
05/02/2007
Last updated
04/22/2021
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