Healthcare Provider Details

I. General information

NPI: 1619546645
Provider Name (Legal Business Name): DIANA HUTCHINGS APRN, AGACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2021
Last Update Date: 06/23/2021
Certification Date: 06/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 MEMORIAL DR
DALTON GA
30720-2529
US

IV. Provider business mailing address

9664 SLIPPERY ELM LN
SODDY DAISY TN
37379-3477
US

V. Phone/Fax

Practice location:
  • Phone: 706-272-6000
  • Fax:
Mailing address:
  • Phone: 423-432-9733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License NumberGAA-NP000264
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: