Healthcare Provider Details

I. General information

NPI: 1225479462
Provider Name (Legal Business Name): MISS DIANNE SINKFIELD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2013
Last Update Date: 07/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4108 GRACEWOOD PARK DR
ELLENWOOD GA
30294-2486
US

IV. Provider business mailing address

4108 GRACEWOOD PARK DR
ELLENWOOD GA
30294-2486
US

V. Phone/Fax

Practice location:
  • Phone: 404-579-7392
  • Fax:
Mailing address:
  • Phone: 404-579-7392
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLPN021626
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: