Provider Demographics
NPI:1609052075
Name:DIOUF, ERICA (CSA)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:DIOUF
Suffix:
Gender:F
Credentials:CSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2844 BARRETT AVE
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31206-4834
Mailing Address - Country:US
Mailing Address - Phone:478-731-9971
Mailing Address - Fax:770-785-9882
Practice Address - Street 1:2844 BARRETT AVE
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31206-4834
Practice Address - Country:US
Practice Address - Phone:478-731-9971
Practice Address - Fax:770-785-9882
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-16
Last Update Date:2009-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA033840149363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical