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Organization
DIVERSIFIED MEDICAL CLINIC, LLC
Active
Organization
DIVERSIFIED MEDICAL CLINIC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LATOYA KATRESE BUFORD DNP, APRN, FNP-BC (NURSE PRACTITIONER/OWNER)
(678) 830-2294
Entity
Organization
Contact information
Practice address
305 CARROLLTON ST, TEMPLE, GA 30179-3796
(678) 830-2294
(678) 890-5840
Mailing address
305 CARROLLTON ST, TEMPLE, GA 30179-3796
(678) 830-2294
(678) 890-5840
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
—
NULL
363LP2300X
Primary Care Nurse Practitioner
Primary
—
NULL
363LP2300X
Primary Care Nurse Practitioner
Primary
—
—
Other
Enumeration date
12/20/2021
Last updated
11/04/2022
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