Provider Demographics
NPI:1629334487
Name:DIEHL III, ALBERT H III (MD)
Entity Type:Individual
Prefix:
First Name:ALBERT
Middle Name:H
Last Name:DIEHL III
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ALEX
Other - Middle Name:
Other - Last Name:DIEHL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:275 COLLIER ROAD NW
Mailing Address - Street 2:SUITE 470
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309
Mailing Address - Country:US
Mailing Address - Phone:404-351-1002
Mailing Address - Fax:404-350-8290
Practice Address - Street 1:275 COLLIER ROAD NW
Practice Address - Street 2:SUITE 470
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309
Practice Address - Country:US
Practice Address - Phone:404-351-1002
Practice Address - Fax:404-350-8290
Is Sole Proprietor?:No
Enumeration Date:2012-04-05
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0776092086X0206X
GA77609208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003193551GMedicaid