MEDICARE: DR. ELOY EDILBERTO DIAZ SR. M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	022956	GA

General Provider Information

NPI Number	:	1063461051
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELOY EDILBERTO DIAZ SR. M.D.

Provider Business Mailing Address
First Line	:	3144 NOAHS ARK RD
Second Line	:
City	:	JONESBORO
State	:	GA
Zip	:	30236-6229
Country	:	US
Telephone Number	:	770-478-8278
Fax Number	:

Provider Business Practice Location Address
First Line	:	6572 RIVER PARK DR STE 102
Second Line	:
City	:	RIVERDALE
State	:	GA
Zip	:	30274-2214
Country	:	US
Telephone Number	:	770-629-2296
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/08/2006
Last Update Date	:	11/19/2021

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