Individual
JACOB L DIDAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
3966 BARRETT ST, AUGUSTA, GA 30909-9554
(716) 418-2305
Mailing address
3966 BARRETT ST, AUGUSTA, GA 30909-9554
(716) 418-2305
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
F404816-01
NY
Other
Enumeration date
03/10/2023
Last updated
03/10/2023
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