MEDICARE: DIANE LINDA HEATH MD

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	035439	GA

General Provider Information

NPI Number	:	1609068865
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANE LINDA HEATH MD

Provider Business Mailing Address
First Line	:	740 FERST DR
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30332-0470
Country	:	US
Telephone Number	:	404-894-1428
Fax Number	:	404-385-0717

Provider Business Practice Location Address
First Line	:	740 FERST DR
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30332-0470
Country	:	US
Telephone Number	:	404-894-1428
Fax Number	:	404-385-0717

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

Provider Enumeration Date	:	08/13/2007
Last Update Date	:	08/13/2007

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