Provider Demographics
NPI:1225192032
Name:WACHMAN, DIANE (DC)
Entity Type:Individual
Prefix:DR
First Name:DIANE
Middle Name:
Last Name:WACHMAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3006 SILVAPINE TRL NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30345-3736
Mailing Address - Country:US
Mailing Address - Phone:404-634-2225
Mailing Address - Fax:404-634-9407
Practice Address - Street 1:1989 N. WILLIAMSBURG DRIVE
Practice Address - Street 2:SUITE D
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033
Practice Address - Country:US
Practice Address - Phone:404-634-2225
Practice Address - Fax:404-634-9407
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA3138111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA35ZCDBXMedicare PIN
GAGRP7167Medicare UPIN