Individual
DR. HENRY LEON DIVERSI JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD MSD
Contact information
Practice address
1895 PHOENIX BLVD, SUITE 138, ATLANTA, GA 30349
(770) 996-2900
(770) 996-0403
Mailing address
1895 PHOENIX BLVD, SUITE 138, ATLANTA, GA 30349
(770) 996-2900
(770) 996-0403
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
6518
GA
Other
Enumeration date
01/23/2007
Last updated
07/08/2007
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