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NPI Code Detail

MEDICARE: DR. DIANE NYKAMP MCCORTER PHARMD

MEDICARE: DR. DIANE NYKAMP MCCORTER PHARMD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist13548GA
2183500000XPharmacist19512FL

General Provider Information

NPI Number : 1265433387
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DIANE NYKAMP MCCORTER PHARMD
Provider Business Mailing Address
First Line : 3001 MERCER UNIVERSITY DR
Second Line :
City : ATLANTA
State : GA
Zip : 30341-4115
Country : US
Telephone Number : 678-547-6219
Fax Number : 678-547-3384
Provider Business Practice Location Address
First Line : 5673 PEACHTREE DUNWOODY RD NE
Second Line : SUITE 490
City : ATLANTA
State : GA
Zip : 30342-1731
Country : US
Telephone Number : 404-851-7633
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/10/2005
Last Update Date : 07/08/2007

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