Provider Demographics
NPI:1659619377
Name:SIMEONOVA, DIANA I (DIPL-PSYCH, PHD)
Entity Type:Individual
Prefix:DR
First Name:DIANA
Middle Name:I
Last Name:SIMEONOVA
Suffix:
Gender:F
Credentials:DIPL-PSYCH, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1365 CLIFTON ROAD NE, SUITE 6100B
Mailing Address - Street 2:THE EMORY CLINIC/PSYCHIATRY
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30322
Mailing Address - Country:US
Mailing Address - Phone:404-778-2524
Mailing Address - Fax:
Practice Address - Street 1:1365 CLIFTON RD NE
Practice Address - Street 2:THE EMORY CLINIC PSYCHIATRY SUITE 6100B
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322-1013
Practice Address - Country:US
Practice Address - Phone:404-778-2524
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-31
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY003643103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical