Healthcare Provider Details

I. General information

NPI: 1396993531
Provider Name (Legal Business Name): DIOGO C. HAUSSEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2008
Last Update Date: 06/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 JESSE HILL JR DR SE # 11C-028
ATLANTA GA
30303-3031
US

IV. Provider business mailing address

80 JESSE HILL JR DR SE # 11C-028
ATLANTA GA
30303-3031
US

V. Phone/Fax

Practice location:
  • Phone: 404-616-4013
  • Fax:
Mailing address:
  • Phone: 404-616-4013
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084V0102X
TaxonomyVascular Neurology Physician
License Number72041
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: