Provider Demographics
NPI:1932657640
Name:PERRY, DIANNA MICHELLE (NP)
Entity Type:Individual
Prefix:
First Name:DIANNA
Middle Name:MICHELLE
Last Name:PERRY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:DIANNA
Other - Middle Name:MICHELLE
Other - Last Name:PETERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:PO BOX 743070
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3070
Mailing Address - Country:US
Mailing Address - Phone:864-560-4304
Mailing Address - Fax:864-560-4413
Practice Address - Street 1:722 HYATT ST
Practice Address - Street 2:
Practice Address - City:GAFFNEY
Practice Address - State:SC
Practice Address - Zip Code:29341-2643
Practice Address - Country:US
Practice Address - Phone:864-489-2400
Practice Address - Fax:864-488-3987
Is Sole Proprietor?:No
Enumeration Date:2016-09-12
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC20475363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP4282Medicaid
SCSC97646084OtherMEDICARE PIN
SCSC9764J577OtherMEDICARE PIN
SCSC97646067OtherMEDICARE PIN