MEDICARE: DR. DIANA DENMAN 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	390200000X	Student in an Organized Health Care Education/Training Program	0116027875	VA
2	390200000X	Student in an Organized Health Care Education/Training Program	MT202728	PA
3	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	000000	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0116027875	OTHER	VA	VIRGINIA MEDICAL BOARD

General Provider Information

NPI Number	:	1962778027
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DIANA DENMAN M.D.

Provider Business Mailing Address
First Line	:	3400 OLD MILTON PKWY STE A130
Second Line	:
City	:	ALPHARETTA
State	:	GA
Zip	:	30005-4417
Country	:	US
Telephone Number	:	770-664-8898
Fax Number	:

Provider Business Practice Location Address
First Line	:	3400 OLD MILTON PKWY STE A130
Second Line	:
City	:	ALPHARETTA
State	:	GA
Zip	:	30005-4417
Country	:	US
Telephone Number	:	770-664-8898
Fax Number	:	770-772-4377

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

Provider Enumeration Date	:	03/22/2012
Last Update Date	:	02/02/2021

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