Individual
JENNIFER CARLITA PETERS-DIAMOND
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
111 W STONE DR, SUITE 110, KINGSPORT, TN 37660-6027
(423) 723-2030
(423) 247-4110
Mailing address
105 W STONE DR, SUITE 6A, KINGSPORT, TN 37660-3365
(423) 408-7220
(423) 408-7405
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
0101240169
VA
207Q00000X
Family Medicine Physician
Primary
48169
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
007604092
—
VA
Enumeration date
11/01/2006
Last updated
08/19/2024
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