Individual
DR. DIANA L. WALTHER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
1421 LEE STREET, BRUNSWICK, GA 31520
(912) 265-0007
(912) 261-0593
Mailing address
1421 LEE STREET, BRUNSWICK, GA 31520
(912) 265-0007
(912) 261-0593
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PSY002320
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10049299
AMERIGROUP
GA
01
—
52769914
BLUE CROSS BLUE SHIELD
GA
Enumeration date
10/03/2006
Last updated
07/08/2007
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