Provider Demographics
NPI:1417989740
Name:COUNCE, DIANE R (MD)
Entity Type:Individual
Prefix:DR
First Name:DIANE
Middle Name:R
Last Name:COUNCE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 SOUTHLAKE PARK STE 200
Mailing Address - Street 2:SUITE 400B
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35244-5700
Mailing Address - Country:US
Mailing Address - Phone:205-699-1632
Mailing Address - Fax:866-546-2124
Practice Address - Street 1:1000 SOUTHLAKE PARK STE 200
Practice Address - Street 2:SUITE 400B
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35244-5700
Practice Address - Country:US
Practice Address - Phone:205-699-1632
Practice Address - Fax:866-546-2124
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2015-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL211242084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1417989740Medicaid
AL510G700045OtherMEDICARE GROUP PIN
510I130003Medicare PIN
AL510G700045OtherMEDICARE GROUP PIN