Provider Demographics
NPI:1437113495
Name:DUVALL, DIANE V (MD)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:V
Last Name:DUVALL
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 1:1800 HOWELL MILL RD NW
Mailing Address - Street 2:SUITE 680
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30318-2538
Mailing Address - Country:US
Mailing Address - Phone:404-352-1730
Mailing Address - Fax:404-352-6907
Practice Address - Street 1:1800 HOWELL MILL RD NW
Practice Address - Street 2:SUITE 680
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30318-2538
Practice Address - Country:US
Practice Address - Phone:404-352-1730
Practice Address - Fax:404-352-6907
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2012-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA033739207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1164605150OtherORGANIZATIONAL NPI
GA1164605150OtherORGANIZATIONAL NPI
GAF65503Medicare UPIN
GA070017275Medicare PIN