Individual
DIANDREA WYNN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1364 CLIFTON RD NE, ATLANTA, GA 30322-1059
(404) 727-5658
Mailing address
12 EXECUTIVE PARK DR NE STE 142, ATLANTA, GA 30329-2206
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
112564
GA
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
GA
Other
Enumeration date
04/02/2026
Last updated
04/26/2026
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