Healthcare Provider Details

I. General information

NPI: 1114109105
Provider Name (Legal Business Name): DIANOVA DIABETIC SYSTEMS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2007
Last Update Date: 11/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7105 S SPRINGS DR SUITE 208
FRANKLIN TN
37067-1710
US

IV. Provider business mailing address

7105 S. SPRINGS DR SUITE 208
FRANKLIN TN
37067
US

V. Phone/Fax

Practice location:
  • Phone: 404-964-5938
  • Fax:
Mailing address:
  • Phone: 404-964-5938
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: ISRAEL EDWARD ROLLINS JR.
Title or Position: CEO
Credential: R.PH.
Phone: 404-964-5938