Provider Demographics
NPI:1972593713
Name:GEORGE, DIANE THOMPSON (MD)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:THOMPSON
Last Name:GEORGE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 MURPHY AVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-1835
Mailing Address - Country:US
Mailing Address - Phone:615-329-6745
Mailing Address - Fax:615-515-6553
Practice Address - Street 1:2201 MURPHY AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-1835
Practice Address - Country:US
Practice Address - Phone:615-329-6745
Practice Address - Fax:615-515-6553
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN25290207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3082513Medicaid
TN3082517Medicare ID - Type Unspecified
TN3082513Medicaid