Organization
DIANA L. WALTHER, PH.D. PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DIANA L WALTHER PH.D. (PSYCHOLOGIST/OWNER)
(912) 265-0007
Entity
Organization
Contact information
Practice address
1421 LEE ST, BRUNSWICK, GA 31520-7132
(912) 265-0007
(912) 261-0593
Mailing address
1421 LEE ST, BRUNSWICK, GA 31520-7132
(912) 265-0007
(912) 261-0593
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PSY002320
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000829606D
—
GA
01
—
10049299
AMERIGROUP
GA
Enumeration date
07/08/2008
Last updated
07/08/2008
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