Individual
DIANA RICO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2110 FAIRBURN RD, DOUGLASVILLE, GA 30135-1080
(770) 896-6518
Mailing address
PO BOX 385, POWDER SPRINGS, GA 30127-0385
(770) 896-6518
(678) 567-1926
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
12/18/2006
Last updated
07/09/2007
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