Delta Comprehensive Injury and Wellness Center LLC

Primary specialty

Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X

Legal business name

DELTA COMPREHENSIVE INJURY AND WELLNESS CENTER LLC

Practice address

1790 Mulkey Rd Ste 1314
Austell, GA 30106-1122

Phone

(770) 284-3832

NPI assigned

Oct 3, 2022

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jose MartiNPI 1902206576

Title

Owner

Phone

(678) 401-3033

Specialties & licenses 2

Addresses

Other names 1

• Delta Orthopedics Doing business as

Medicare fee-for-service enrollment

Enrolled in GA2 enrollments

Enrollment records 2

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jose Marti, PA-C

  • Physician Assistant
  • Austell, GA
  • NPI 1902206576
  Medicare reassignment Authorized official
• Venu M. Madhipatla, MD

  • Interventional Pain Medicine Physician
  • Lawrenceville, GA
  • NPI 1578623278
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1664755200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1688083200000",
    "number": "1124742218",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1790 MULKEY RD STE 1314",
            "city": "AUSTELL",
            "state": "GA",
            "postal_code": "301061122"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1790 MULKEY RD STE 1314",
            "city": "AUSTELL",
            "state": "GA",
            "postal_code": "301061122",
            "telephone_number": "770-284-3832"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DELTA COMPREHENSIVE INJURY AND WELLNESS CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-10-03",
        "last_updated": "2023-06-30",
        "certification_date": "2023-06-30",
        "status": "A",
        "authorized_official_last_name": "MARTI",
        "authorized_official_first_name": "JOSE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "678-401-3033"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Delta Orthopedics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Victor Linelle Davis
• Kristi S Dean, THERAPY DIR. I
• Raquel M Decamp, PA-C
• Victoria Milayne Deeson
• Amber Nicole Delaney, DNP, APRN, FNP-C
• Deluxe Senior Care
• Despina Demestihas Dalton, MD
• Denmark Surgical Associates
• Dentalogy LLC
• Dentistry for Children of Austell, LLC

• Multi-Specialty Clinic/Center in Austell, GA
• Providers in Austell, GA by specialty
• Multi-Specialty Clinic/Center in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.