Provider Demographics
NPI:1609011402
Name:CONSTANTE, DIEGO (LMT)
Entity Type:Individual
Prefix:MR
First Name:DIEGO
Middle Name:
Last Name:CONSTANTE
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 JOHNSON LAKE RD SE
Mailing Address - Street 2:
Mailing Address - City:ADAIRSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30103-3707
Mailing Address - Country:US
Mailing Address - Phone:706-844-2142
Mailing Address - Fax:
Practice Address - Street 1:108 OOTHCALOOGA ST
Practice Address - Street 2:
Practice Address - City:CALHOUN
Practice Address - State:GA
Practice Address - Zip Code:30701-2332
Practice Address - Country:US
Practice Address - Phone:706-625-3585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-08
Last Update Date:2008-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist