Individual
MS. HOLLY JOY DIBERT I
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
1014 SYCAMORE DR STE B, DECATUR, GA 30030-1644
(404) 299-1700
(404) 299-1616
Mailing address
2610 AVERY PARK CIR, ATLANTA, GA 30360-2576
(404) 285-5560
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
00300
IA
174400000X
Specialist
1835
MN
246ZS0410X
Surgical Technologist
Primary
10-0825
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1518959006
DR. BENDIKS
GA
Enumeration date
06/22/2007
Last updated
10/31/2011
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