Healthcare Provider Details

I. General information

NPI: 1437131380
Provider Name (Legal Business Name): DIANE KATHLEEN CERJAN PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2005
Last Update Date: 06/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

506 N JACKSON ST THE RENAISSANCE CENTRE
ALBANY GA
31701-2308
US

IV. Provider business mailing address

1800 ROBINHOOD RD
ALBANY GA
31707
US

V. Phone/Fax

Practice location:
  • Phone: 229-889-7200
  • Fax: 229-889-7393
Mailing address:
  • Phone: 229-889-7200
  • Fax: 229-889-7393

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberGA2049
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: