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General NPI Number Information
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NPI Number | 1396903068
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Entity Type | Individual
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Provider Name | DIANNA PLYLER KUBACZ MD
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Gender | Female
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Dates
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Enumeration Date | 05/29/2008
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Last Update Date | 04/01/2025
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Provider Practice Location Address
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Address Line | 1304 SPRINGDALE DR
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City | CLINTON
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State | SC
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Zip | 29325-7226
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Country | US
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Telephone | 864-833-6287
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 470408
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City | CHARLOTTE
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State | NC
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Zip | 28247-0408
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Country | US
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Telephone | 704-375-0100
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Fax | 704-887-6450
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 83623
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License Number State | SC
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