Individual
ANNE MARIE DIAZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
410 CONNELL ROAD SUITE T, VALDOSTA, GA 31602-3160
(229) 244-4720
Mailing address
410 CONNELL RD STE T, VALDOSTA, GA 31602-1899
(229) 244-4720
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
AG09180071
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
059917025
DRIVERS LICENSE
GA
Enumeration date
10/31/2018
Last updated
06/11/2019
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