Healthcare Provider Details

I. General information

NPI: 1154854396
Provider Name (Legal Business Name): DIANA TIWARI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2017
Last Update Date: 06/27/2023
Certification Date: 06/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49 JESSE HILL JR DR SE #480A
ATLANTA GA
30303-3049
US

IV. Provider business mailing address

49 JESSE HILL JR DR SE #480A
ATLANTA GA
30303-3049
US

V. Phone/Fax

Practice location:
  • Phone: 404-251-8796
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number95360
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number009321
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberME153996
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: