Healthcare Provider Details

I. General information

NPI: 1750109534
Provider Name (Legal Business Name): EMILY DIAZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2024
Last Update Date: 09/30/2024
Certification Date: 09/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

84 ESTEN ST SE
ATLANTA GA
30316-1358
US

IV. Provider business mailing address

84 ESTEN ST SE
ATLANTA GA
30316-1358
US

V. Phone/Fax

Practice location:
  • Phone: 404-395-9763
  • Fax:
Mailing address:
  • Phone: 404-395-9763
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License NumberRN301157
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: