Provider Demographics
NPI:1568939486
Name:DIVERSE IMAGES MANAGEMENT SERVICES LLC,
Entity Type:Organization
Organization Name:DIVERSE IMAGES MANAGEMENT SERVICES LLC,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:DEEANN
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-886-0284
Mailing Address - Street 1:PO BOX 366037
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30336-6037
Mailing Address - Country:US
Mailing Address - Phone:678-886-0284
Mailing Address - Fax:
Practice Address - Street 1:3724 MARTIN LUTHER KING DR SW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-3600
Practice Address - Country:US
Practice Address - Phone:678-886-0284
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-29
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case ManagementGroup - Single Specialty