MEDICARE: MRS. DIANNE WEST

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
1	2278P4000X	Patient Transport Certified Respiratory Therapist

General Provider Information

NPI Number	:	1588358659
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DIANNE WEST

Provider Business Mailing Address
First Line	:	4714 AUGUSTA RD
Second Line	:
City	:	GARDEN CITY
State	:	GA
Zip	:	31408-1727
Country	:	US
Telephone Number	:	912-507-7511
Fax Number	:

Provider Business Practice Location Address
First Line	:	4714 AUGUSTA RD
Second Line	:
City	:	GARDEN CITY
State	:	GA
Zip	:	31408-1727
Country	:	US
Telephone Number	:	912-507-7511
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/02/2023
Last Update Date	:	06/02/2023

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Directions to “ MRS. DIANNE WEST ” Practice Location

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