Healthcare Provider Details

I. General information

NPI: 1295466571
Provider Name (Legal Business Name): SAUL ENMANUEL DIAZ-MARIN PMHNP-BC, FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: SAUL ENMANUEL DIAZ PMHNP-BC, FNP-BC

II. Dates (important events)

Enumeration Date: 06/18/2022
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2030 MAIN ST NW APT 201
ATLANTA GA
30318-1877
US

IV. Provider business mailing address

2030 MAIN ST NW APT 201
ATLANTA GA
30318-1877
US

V. Phone/Fax

Practice location:
  • Phone: 470-419-9196
  • Fax:
Mailing address:
  • Phone: 470-419-9196
  • Fax: 470-444-9186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN-NP712519
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: