Healthcare Provider Details

I. General information

NPI: 1114925872
Provider Name (Legal Business Name): FRANK R DON DIEGO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 05/26/2021
Certification Date: 05/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 SHORTER AVE NW STE 201
ROME GA
30165-4290
US

IV. Provider business mailing address

420 E 2ND AVE SUITE 103
ROME GA
30161-3209
US

V. Phone/Fax

Practice location:
  • Phone: 706-509-3300
  • Fax: 706-509-3331
Mailing address:
  • Phone: 706-509-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number026505
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: