Healthcare Provider Details

I. General information

NPI: 1902939440
Provider Name (Legal Business Name): DIONE MARIE CENTRELLA PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DIONE MARIE CENTRELLA PHARMD

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1524 GA-16
GRIFFIN GA
30223
US

IV. Provider business mailing address

1524 SR-16 E
GRIFFIN GA
30223
US

V. Phone/Fax

Practice location:
  • Phone: 770-229-7430
  • Fax: 770-229-7435
Mailing address:
  • Phone: 770-229-7430
  • Fax: 770-229-7435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number022604
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: