Provider Demographics
NPI:1073791190
Name:SODIQ, DIANA KHARBAT (DO)
Entity Type:Individual
Prefix:DR
First Name:DIANA
Middle Name:KHARBAT
Last Name:SODIQ
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:
Other - Last Name:KHARBAT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:635 WILLOWBROOK RUN
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-8139
Mailing Address - Country:US
Mailing Address - Phone:404-821-2951
Mailing Address - Fax:
Practice Address - Street 1:198 HAMPTON ST
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-3152
Practice Address - Country:US
Practice Address - Phone:770-957-9081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-31
Last Update Date:2019-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2199208100000X
GA63026208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty