MEDICARE: DR. DAVID A. DIA PH.D., LCSW

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	1041C0700X	Clinical Social Worker	4736	TN

General Provider Information

NPI Number	:	1639173917
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID A. DIA PH.D., LCSW

Provider Business Mailing Address
First Line	:	2014 EXETER RD
Second Line	:
City	:	GERMANTOWN
State	:	TN
Zip	:	38138-3945
Country	:	US
Telephone Number	:	901-624-4600
Fax Number	:	901-757-1485

Provider Business Practice Location Address
First Line	:	2014 EXETER RD
Second Line	:
City	:	GERMANTOWN
State	:	TN
Zip	:	38138-3945
Country	:	US
Telephone Number	:	901-624-4600
Fax Number	:	901-757-1485

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

Provider Enumeration Date	:	06/02/2005
Last Update Date	:	07/08/2007

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