Provider Demographics
NPI:1871707661
Name:DELIMA, CESAR MEDALLA (MD)
Entity type:Individual
Prefix:DR
First Name:CESAR
Middle Name:MEDALLA
Last Name:DELIMA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2151B W SPRING ST
Mailing Address - Street 2:STE 210
Mailing Address - City:MONROE
Mailing Address - State:GA
Mailing Address - Zip Code:30655-3115
Mailing Address - Country:US
Mailing Address - Phone:770-267-2790
Mailing Address - Fax:770-207-0652
Practice Address - Street 1:333 ALCOVY STREET
Practice Address - Street 2:SUITE 10
Practice Address - City:MONROE
Practice Address - State:GA
Practice Address - Zip Code:30655
Practice Address - Country:US
Practice Address - Phone:770-267-2790
Practice Address - Fax:770-207-0652
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA028396208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000324244DMedicaid
GA52238010OtherBLUE CROSS BLUE SHIELD
GA511I020059Medicare Oscar/Certification
D39721Medicare UPIN
D39721Medicare PIN
GA000324244DMedicaid