Healthcare Provider Details

I. General information

NPI: 1124588603
Provider Name (Legal Business Name): ANDRIA DIAMOND AGACNP, RN, RNFA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2019
Last Update Date: 06/03/2022
Certification Date: 06/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3675 J DEWEY GRAY CIR STE 300
AUGUSTA GA
30909-1868
US

IV. Provider business mailing address

3675 J DEWEY GRAY CIR STE 300
AUGUSTA GA
30909-1868
US

V. Phone/Fax

Practice location:
  • Phone: 706-863-9595
  • Fax:
Mailing address:
  • Phone: 706-863-9595
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPN0000029596
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberGAA-NP000220
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: