Provider Demographics
NPI:1972788719
Name:OLSEN, DIANA L (DVM)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:L
Last Name:OLSEN
Suffix:
Gender:F
Credentials:DVM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1093 SANDY PLAINS RD
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-6537
Mailing Address - Country:US
Mailing Address - Phone:770-424-6303
Mailing Address - Fax:770-426-4257
Practice Address - Street 1:1093 SANDY PLAINS RD
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30066-6537
Practice Address - Country:US
Practice Address - Phone:770-424-6303
Practice Address - Fax:770-426-4257
Is Sole Proprietor?:No
Enumeration Date:2007-12-28
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAVET004761174M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174M00000XOther Service ProvidersVeterinarian