Horace Michael Delisser Jr., PA
Individual provider Active NPI Surgical Physician Assistant · Bethlehem, GA
NPI 1306357256 · NPPES record last updated Jan 16, 2023
Key facts
- NPI
- 1306357256
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Surgical Physician Assistant 363AS0400X
- License
- 11352 (GA)
- Practice address
- 426 Exchange Blvd Ste 600
Bethlehem, GA 30620-1794 - Phone
- (770) 848-6190
- NPI assigned
- Oct 18, 2017
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230124000729 | GA | Practitioner - Physician Assistant | 9032478789 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11352 | GA | MD | Surgical Physician Assistant |
| 25MP00494800 | NJ | MD | Surgical Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Thrive Orthopaedics LLC | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgical Physician Assistant | 363AS0400X | |||
| Surgical Physician Assistant | 363AS0400X | 11352 | GA | Yes |
| Surgical Physician Assistant | 363AS0400X | MA059415 | PA | |
| Surgical Physician Assistant | 363AS0400X | 25MP00494800 | NJ |
Addresses
Primary practice location
426 Exchange Blvd Ste 600
Bethlehem, GA 30620-1794
Mailing address
PO Box 742616
Atlanta, GA 30374-2616
Phone (770) 219-8420
Other practice location 1
150 Delsea Dr Ste B
Sewell, NJ 08080-9478
Phone (856) 302-0500
Other practice location 2
479 Thomas Jones Way Ste 300
Exton, PA 19341-2552
Phone (610) 280-9999
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | hdelisser156848@nghs.gadirect.net | Direct |
Other providers in Bethlehem, GA
- Community Medical Transport LLC
- Christina Danielle Copeland
- Dawn Crook
- Timothy Arnold Cummins
- Ethan James Darcy
- Kallie Dennis
- Baltej Singh Dhillon
- Lucinda A Dixon
- Jonnica Shenea Dozier
- Matthew Dubose
All providers in Bethlehem, GA · Surgical Physician Assistant in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 16, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.