Provider Demographics
NPI:1114905379
Name:DIAMOND, ANDREW (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:
Last Name:DIAMOND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1360 UPPER HEMBREE RD
Mailing Address - Street 2:SUITE 201B
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-1171
Mailing Address - Country:US
Mailing Address - Phone:770-475-3361
Mailing Address - Fax:770-664-4431
Practice Address - Street 1:1360 UPPER HEMBREE RD
Practice Address - Street 2:SUITE 201
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-1171
Practice Address - Country:US
Practice Address - Phone:770-475-3361
Practice Address - Fax:770-664-4431
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA036368207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000539129HMedicaid
GA000539129IMedicaid
GA000539129IMedicaid
GA000539129HMedicaid