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General NPI Number Information
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NPI Number | 1285101964
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Entity Type | Individual
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Provider Name | ANNE MARIE DIAZ
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Gender | Female
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Dates
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Enumeration Date | 10/31/2018
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Last Update Date | 06/11/2019
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Provider Practice Location Address
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Address Line | 410 CONNELL ROAD SUITE T
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City | VALDOSTA
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State | GA
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Zip | 31602-3160
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Country | US
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Telephone | 229-244-4720
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Fax |
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Provider Business Mailing Address
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Address Line | 410 CONNELL RD STE T
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City | VALDOSTA
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State | GA
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Zip | 31602-1899
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Country | US
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Telephone | 229-244-4720
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Fax |
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | AG09180071
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License Number State | GA
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