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General NPI Number Information
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NPI Number | 1073552196
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Entity Type | Individual
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Provider Name | DIANA ALMA SANTIAGO MD
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Gender | Female
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Dates
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Enumeration Date | 06/05/2006
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Last Update Date | 12/27/2021
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Provider Practice Location Address
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Address Line | 745 POPLAR RD
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City | NEWNAN
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State | GA
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Zip | 30265-1618
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Country | US
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Telephone | 770-400-4700
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Fax | 770-400-4096
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Provider Business Mailing Address
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Address Line | 255 PROFESSIONAL CT
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City | RIVERDALE
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State | GA
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Zip | 30274-2531
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Country | US
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Telephone | 770-907-0554
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Fax | 770-907-9048
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 42421
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | 42421
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License Number State | GA
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