Provider Demographics
NPI:1235105032
Name:KING, DIANE GREEN (ATC, RD, CSSD)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:GREEN
Last Name:KING
Suffix:
Gender:F
Credentials:ATC, RD, CSSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:328 RHODES HOUSE CT
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-6472
Mailing Address - Country:US
Mailing Address - Phone:770-831-4743
Mailing Address - Fax:
Practice Address - Street 1:410 PEACHTREE PKWY
Practice Address - Street 2:SUITE 300
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-7066
Practice Address - Country:US
Practice Address - Phone:404-354-0008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2014-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1112255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer