Provider Demographics
NPI:1952464224
Name:WARREN, DIANE W
Entity Type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:W
Last Name:WARREN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2842 DA VINCI BLVD
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30034-3117
Mailing Address - Country:US
Mailing Address - Phone:404-284-4302
Mailing Address - Fax:404-288-7530
Practice Address - Street 1:2842 DA VINCI BLVD
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30034-3117
Practice Address - Country:US
Practice Address - Phone:404-284-4302
Practice Address - Fax:404-288-7530
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA171M00000X171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator