Healthcare Provider Details

I. General information

NPI: 1437113495
Provider Name (Legal Business Name): DIANE V DUVALL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2006
Last Update Date: 01/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 HOWELL MILL RD NW SUITE 680
ATLANTA GA
30318-2538
US

IV. Provider business mailing address

1800 HOWELL MILL RD NW SUITE 680
ATLANTA GA
30318-2538
US

V. Phone/Fax

Practice location:
  • Phone: 404-352-1730
  • Fax: 404-352-6907
Mailing address:
  • Phone: 404-352-1730
  • Fax: 404-352-6907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number033739
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: