# DIVERSIFIED MEDICAL, PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1811093693
- **Authorized official:** DR. WILLIAM CHARLES VAN NESS M.D. (OWNER/CEO)
- **Authorized official phone:** (866) 434-8633

## Contact information

- **Practice address:** 200 N HARBOR PL, SUITES B/C, DAVIDSON, NC 28036-7918
- **Practice address phone:** (866) 434-8633
- **Mailing address:** 200 N HARBOR PL, SUITES B/C, DAVIDSON, NC 28036-7918

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208100000X | Physical Medicine & Rehabilitation Physician | 00023727 | AL | — |
| 208100000X | Physical Medicine & Rehabilitation Physician | 0101239263 | VA | — |
| 208100000X | Physical Medicine & Rehabilitation Physician | 01061499A | IN | — |
| 208100000X | Physical Medicine & Rehabilitation Physician | 049747 | GA | — |
| 208100000X | Physical Medicine & Rehabilitation Physician | 237905 | NY | — |
| 208100000X | Physical Medicine & Rehabilitation Physician | 33150 | KY | — |
| 208100000X | Physical Medicine & Rehabilitation Physician | 35 087813 | OH | — |
| 208100000X | Physical Medicine & Rehabilitation Physician | D0063862 | MD | — |
| 208100000X | Physical Medicine & Rehabilitation Physician | MD 073346-L | PA | — |
| 208100000X | Physical Medicine & Rehabilitation Physician | ME 95839 | FL | — |
| 208100000X | Physical Medicine & Rehabilitation Physician | TL28503 | SC | — |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | IL | — |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | NC | Yes |

## Other

- **Enumeration date:** 09/16/2006
- **Last updated:** 08/22/2020