Healthcare Provider Details

I. General information

NPI: 1255856167
Provider Name (Legal Business Name): DIANNA G OSBORN MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2017
Last Update Date: 08/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15243 GREENFIELD DR
ATHENS AL
35613-2899
US

IV. Provider business mailing address

24552 LEATHA MAE WAY
ATHENS AL
35613-3234
US

V. Phone/Fax

Practice location:
  • Phone: 256-216-3505
  • Fax: 256-216-3506
Mailing address:
  • Phone: 256-777-1255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number015167
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code207PE0005X
TaxonomyUndersea and Hyperbaric Medicine (Emergency Medicine) Physician
License Number15167
License Number StateAL

VIII. Authorized Official

Name: DIANNA G OSBORN
Title or Position: PRESIDENT
Credential: MD
Phone: 256-777-1255