Provider Demographics
NPI:1639142979
Name:BILES, DIADRA MICHELLE (DPM)
Entity Type:Individual
Prefix:DR
First Name:DIADRA
Middle Name:MICHELLE
Last Name:BILES
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:DR
Other - First Name:DIADRA
Other - Middle Name:MICHELLE
Other - Last Name:BILES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPM
Mailing Address - Street 1:792 CHURCH ST NE
Mailing Address - Street 2:MARIETTA
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-8954
Mailing Address - Country:US
Mailing Address - Phone:770-422-9856
Mailing Address - Fax:770-984-0303
Practice Address - Street 1:792 CHURCH ST NE
Practice Address - Street 2:MARIETTA
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-8954
Practice Address - Country:US
Practice Address - Phone:770-422-9856
Practice Address - Fax:770-984-0303
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPOD000932213E00000X
FLPO2758213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
7101735OtherAETNA
GA0940220002OtherDMERC
U73476Medicare UPIN
GAGRP1534Medicare PIN
7101735OtherAETNA