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Individual

DIOSITA WATIN LARIOSA

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
M.D.,P.C.

Contact information

Practice address
513 W 2ND AVE, ALBANY, GA 31701-2204
(229) 432-7444
(229) 432-7445
Mailing address
513 W 2ND AVE, ALBANY, GA 31701-2204
(229) 432-7444
(229) 432-7445

Taxonomy

Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
21325
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000236959A
PEACHSTATE MEDICAID
GA
05
000236959A
GA
01
336022
WELLCARE MEDICAID
GA
Enumeration date
01/30/2007
Last updated
04/17/2008
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