Individual
MARY DIANE KINSELLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1412 MILSTEAD AVE NE DEPT OF, CONYERS, GA 30012
(678) 423-1550
(678) 423-1550
Mailing address
5700 SOUTHWYCK BLVD, TOLEDO, OH 43614-1509
(800) 288-8325
(419) 866-5453
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
002586
GA
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
64527
GA
Other
Enumeration date
12/20/2007
Last updated
08/10/2023
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