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General NPI Number Information
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NPI Number | 1508319500
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Entity Type | Individual
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Provider Name | DAVID RYAN DIEHL
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Gender | Male
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Dates
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Enumeration Date | 07/27/2016
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Last Update Date | 08/16/2021
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Provider Practice Location Address
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Address Line | 820 PRUDENTIAL DR SUITE 606
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City | JACKSONVILLE
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State | FL
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Zip | 32207-8210
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Country | US
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Telephone | 904-398-3356
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Fax |
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Provider Business Mailing Address
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Address Line | 810 KENDALL KNOLL WAY
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City | MABLETON
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State | GA
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Zip | 30126-5963
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Country | US
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Telephone | 404-989-3425
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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 | 367H00000X
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Taxonomy Name | Anesthesiologist Assistant
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License Number | 10432
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License Number State | GA
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