Provider Demographics
NPI:1528396702
Name:DIABETES & ENDOCRINE TREATMENT CENTER
Entity Type:Organization
Organization Name:DIABETES & ENDOCRINE TREATMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:912-284-9888
Mailing Address - Street 1:2005 PIONEER ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:WAYCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:31501-6206
Mailing Address - Country:US
Mailing Address - Phone:912-284-9888
Mailing Address - Fax:912-285-8533
Practice Address - Street 1:2005 PIONEER ST
Practice Address - Street 2:SUITE C
Practice Address - City:WAYCROSS
Practice Address - State:GA
Practice Address - Zip Code:31501-6206
Practice Address - Country:US
Practice Address - Phone:912-284-9888
Practice Address - Fax:912-285-8533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-25
Last Update Date:2009-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA035482261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty