Organization
JIMMY DIAZ MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JIMMY DIAZ M.D. (PRESIDENT)
(912) 729-6606
Entity
Organization
Contact information
Practice address
130 N GROSS RD, SUITE 202, KINGSLAND, GA 31548
(912) 729-6606
(912) 729-1214
Mailing address
130 N GROSS RD, SUITE 202, KINGSLAND, GA 31548
(912) 729-6606
(912) 729-1214
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
26097
GA
363AM0700X
Medical Physician Assistant
—
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000320581E
—
GA
Enumeration date
07/12/2007
Last updated
08/01/2008
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