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General NPI Number Information
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NPI Number | 1528623535
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Entity Type | Individual
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Provider Name | DIEGO FERNANDO HERRERA DO
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Gender | Male
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Dates
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Enumeration Date | 05/06/2019
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Last Update Date | 06/05/2025
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Provider Practice Location Address
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Address Line | 81 NORTHSIDE DAWSON DR STE 100
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City | DAWSONVILLE
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State | GA
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Zip | 30534-7164
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Country | US
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Telephone | 855-647-7678
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Fax | 404-847-4232
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Provider Business Mailing Address
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Address Line | 81 NORTHSIDE DAWSON DR STE 100
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City | DAWSONVILLE
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State | GA
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Zip | 30534-7164
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Country | US
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Telephone | 404-847-4230
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Fax | 404-847-4232
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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 | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number | 89688
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 89688
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License Number State | GA
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