Miguel B Delmazo, MD

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

065651 Issued in GA

Practice address

3215 McClure Bridge Rd
Duluth, GA 30096

Phone

(678) 312-6200

Fax

(678) 312-6226

NPI assigned

Feb 11, 2009

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 15

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Interoperability endpoints

• Direct secure messaging: miguel.delmazo.p53@direct.tenet.nextgenshare.com
• Direct secure messaging: miguel.del@longstreetclinic.gadirect.net
• Direct secure messaging: miguel.delmazo.p52@direct.tenet.nextgenshare.com
• Direct secure messaging: miguel.delmazo.p75@direct.tenet.nextgenshare.com
• Direct secure messaging: miguel.delmazo.p50@direct.tenet.nextgenshare.com

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

{
    "created_epoch": "1234310400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1681862400000",
    "number": "1598904740",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5403 OAK CREST LN",
            "city": "BUFORD",
            "state": "GA",
            "postal_code": "305189029",
            "telephone_number": "404-722-9753"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3215 MCCLURE BRIDGE RD",
            "city": "DULUTH",
            "state": "GA",
            "postal_code": "30096",
            "telephone_number": "678-312-6200",
            "fax_number": "678-312-6226"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1120 Peachtree Industrial Blvd Ste 106",
            "address_purpose": "LOCATION",
            "city": "Suwanee",
            "state": "GA",
            "postal_code": "300242322",
            "country_code": "US",
            "telephone_number": "678-207-4620",
            "fax_number": "678-207-4619",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "725 Jesse Jewell Pkwy SE",
            "address_purpose": "LOCATION",
            "city": "Gainesville",
            "state": "GA",
            "postal_code": "305013834",
            "country_code": "US",
            "telephone_number": "770-534-0110",
            "fax_number": "770-531-2422",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1270 Friendship Rd",
            "address_purpose": "LOCATION",
            "city": "Braselton",
            "state": "GA",
            "postal_code": "305175608",
            "country_code": "US",
            "telephone_number": "770-534-0110",
            "fax_number": "770-534-2555",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DELMAZO",
        "first_name": "MIGUEL",
        "middle_name": "B",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-02-11",
        "last_updated": "2023-04-19",
        "certification_date": "2023-04-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "GA",
            "license": "065651",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003114073F",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003114073L",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "9738749",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "52515750",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003114073N",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COVENTRY",
            "identifier": "1489990",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003114073H",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003114073K",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIGROUP",
            "identifier": "02378992",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003114073I",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003114073M",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003114073G",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLCARE",
            "identifier": "1022567",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "9672923",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003114073J",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Surgery Physician in Duluth, GA
• Providers in Duluth, GA by specialty
• Surgery Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.