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NPI Code Detail

MEDICARE: DR. DIAHANN M MEEKINS MOORE MD

MEDICARE: DR. DIAHANN M MEEKINS MOORE 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
12084P0800XPsychiatry Physician66603WI
22084P0800XPsychiatry Physician01070915AIN
32084P0800XPsychiatry Physician63458GA

General Provider Information

NPI Number : 1669707956
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DIAHANN M MEEKINS MOORE MD
Provider Business Mailing Address
First Line : 4828 ASHFORD DUNWOODY RD STE 100
Second Line :
City : ATLANTA
State : GA
Zip : 30338-4833
Country : US
Telephone Number : 707-238-2674
Fax Number : 678-573-4457
Provider Business Practice Location Address
First Line : 4828 ASHFORD DUNWOODY RD STE 100
Second Line :
City : ATLANTA
State : GA
Zip : 30338-4833
Country : US
Telephone Number : 707-238-2674
Fax Number : 678-573-4457
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/05/2009
Last Update Date : 09/11/2024

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