Provider Demographics
NPI:1255856167
Name:DIANNA G OSBORN MD PC
Entity Type:Organization
Organization Name:DIANNA G OSBORN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DIANNA
Authorized Official - Middle Name:G
Authorized Official - Last Name:OSBORN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-777-1255
Mailing Address - Street 1:24552 LEATHA MAE WAY
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:AL
Mailing Address - Zip Code:35613-3234
Mailing Address - Country:US
Mailing Address - Phone:256-777-1255
Mailing Address - Fax:
Practice Address - Street 1:15243 GREENFIELD DR
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:AL
Practice Address - Zip Code:35613-2899
Practice Address - Country:US
Practice Address - Phone:256-216-3505
Practice Address - Fax:256-216-3506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-11
Last Update Date:2017-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL015167207P00000X
AL15167207PE0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No207PE0005XAllopathic & Osteopathic PhysiciansEmergency MedicineUndersea and Hyperbaric MedicineGroup - Multi-Specialty