Individual
DIANA EAP
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
10307 TARA BLVD, JONESBORO, GA 30236-6553
(770) 210-3400
Mailing address
10307 TARA BLVD, JONESBORO, GA 30236-6553
(770) 210-3400
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
030036
GA
Other
Enumeration date
11/23/2020
Last updated
11/23/2020
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