Healthcare Provider Details

I. General information

NPI: 1760410351
Provider Name (Legal Business Name): MATTHEW J. DIAMOND D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 06/08/2021
Certification Date: 06/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 GREENE ST STE 200
AUGUSTA GA
30901-2385
US

IV. Provider business mailing address

701 GREENE ST STE 200
AUGUSTA GA
30901-2385
US

V. Phone/Fax

Practice location:
  • Phone: 706-722-6900
  • Fax: 706-722-5118
Mailing address:
  • Phone: 706-722-6900
  • Fax: 706-722-5118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number057956
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: