Provider Demographics
NPI:1114109105
Name:DIANOVA DIABETIC SYSTEMS, LLC
Entity Type:Organization
Organization Name:DIANOVA DIABETIC SYSTEMS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ISRAEL
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:ROLLINS
Authorized Official - Suffix:JR
Authorized Official - Credentials:RPH
Authorized Official - Phone:404-964-5938
Mailing Address - Street 1:7105 S. SPRINGS DR
Mailing Address - Street 2:SUITE 208
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067
Mailing Address - Country:US
Mailing Address - Phone:404-964-5938
Mailing Address - Fax:
Practice Address - Street 1:7105 S SPRINGS DR
Practice Address - Street 2:SUITE 208
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-1710
Practice Address - Country:US
Practice Address - Phone:404-964-5938
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-30
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies