Provider Demographics
NPI:1023298981
Name:FRANKLIN D. DIAZ, MD, PC
Entity type:Organization
Organization Name:FRANKLIN D. DIAZ, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANKLIN
Authorized Official - Middle Name:D
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-513-8028
Mailing Address - Street 1:601 A PROFESSIONAL DRIVE, SUITE 200
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30045-3004
Mailing Address - Country:US
Mailing Address - Phone:770-513-8028
Mailing Address - Fax:770-513-8653
Practice Address - Street 1:601 A PROFESSIONAL DRIVE, SUITE 200
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30045-3004
Practice Address - Country:US
Practice Address - Phone:770-513-8028
Practice Address - Fax:770-513-8653
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-08
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA032374207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GRP4429OtherMEDICARE GROUP NUMBER
50BBFWLMedicare PIN
G07880Medicare UPIN
39BDBPSMedicare PIN
GRP4429OtherMEDICARE GROUP NUMBER