Provider Demographics
NPI:1124023098
Name:DIAMOND, CHAD J (DO)
Entity Type:Individual
Prefix:DR
First Name:CHAD
Middle Name:J
Last Name:DIAMOND
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:110 MILLSAPS DR
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-1347
Mailing Address - Country:US
Mailing Address - Phone:601-261-5710
Mailing Address - Fax:601-268-5058
Practice Address - Street 1:110 MILLSAPS DR
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-1347
Practice Address - Country:US
Practice Address - Phone:601-261-5710
Practice Address - Fax:601-268-5058
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS16945207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00125973Medicaid
MS00125973Medicaid
MSH58377Medicare UPIN