# DIVERSIFIED MEDICAL CLINIC, LLC

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

## Provider details

- **NPI number:** 1932869856
- **Authorized official:** DR. LATOYA KATRESE BUFORD DNP, APRN, FNP-BC (NURSE PRACTITIONER/OWNER)
- **Authorized official phone:** (678) 830-2294

## Contact information

- **Practice address:** 305 CARROLLTON ST, TEMPLE, GA 30179-3796
- **Practice address phone:** (678) 830-2294
- **Practice address fax:** (678) 890-5840
- **Mailing address:** 305 CARROLLTON ST, TEMPLE, GA 30179-3796
- **Mailing address phone:** (678) 830-2294
- **Mailing address fax:** (678) 890-5840

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QP2300X | Primary Care Clinic/Center | — | NULL | — |
| 363LP2300X | Primary Care Nurse Practitioner | — | NULL | Yes |
| 363LP2300X | Primary Care Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 12/20/2021
- **Last updated:** 11/04/2022