Provider Demographics
NPI:1659665669
Name:DARKS, DIANA MICHELLE (BS)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:MICHELLE
Last Name:DARKS
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:713 CHEATHAM ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:TN
Mailing Address - Zip Code:37172-2828
Mailing Address - Country:US
Mailing Address - Phone:615-463-6200
Mailing Address - Fax:615-463-6202
Practice Address - Street 1:713 CHEATHAM ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:TN
Practice Address - Zip Code:37172-2828
Practice Address - Country:US
Practice Address - Phone:615-463-6200
Practice Address - Fax:615-463-6202
Is Sole Proprietor?:No
Enumeration Date:2011-06-07
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator