Healthcare Provider Details

I. General information

NPI: 1346379518
Provider Name (Legal Business Name): DIANA L HART RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2452 SHEA DR
MACON GA
31206-3865
US

IV. Provider business mailing address

2452 SHEA DR
MACON GA
31206-3865
US

V. Phone/Fax

Practice location:
  • Phone: 478-788-1102
  • Fax: 478-788-1102
Mailing address:
  • Phone: 478-788-1102
  • Fax: 478-788-1102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberNHA004999
License Number StateGA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: