Provider Demographics
NPI:1073551503
Name:SPINNATO, DYAN M (MD)
Entity Type:Individual
Prefix:DR
First Name:DYAN
Middle Name:M
Last Name:SPINNATO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 OAKHURST DR
Mailing Address - Street 2:
Mailing Address - City:NORTH AUGUSTA
Mailing Address - State:SC
Mailing Address - Zip Code:29860-9742
Mailing Address - Country:US
Mailing Address - Phone:803-279-9666
Mailing Address - Fax:
Practice Address - Street 1:4321 UNIVERSITY PKWY
Practice Address - Street 2:SUITE 104
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809-3058
Practice Address - Country:US
Practice Address - Phone:706-854-2600
Practice Address - Fax:706-854-2601
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA05236173000000X
GA0526362080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
No173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA190988196CMedicaid
GA190988196AMedicaid