Provider Demographics
NPI:1649067802
Name:DIALS, DEVOSHA QUANTASIA (FNP)
Entity type:Individual
Prefix:
First Name:DEVOSHA
Middle Name:QUANTASIA
Last Name:DIALS
Suffix:
Gender:
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7581 DEERRIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:FAIRBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30213-6556
Mailing Address - Country:US
Mailing Address - Phone:843-432-6740
Mailing Address - Fax:
Practice Address - Street 1:7581 DEERRIDGE WAY
Practice Address - Street 2:
Practice Address - City:FAIRBURN
Practice Address - State:GA
Practice Address - Zip Code:30213-6556
Practice Address - Country:US
Practice Address - Phone:843-432-6740
Practice Address - Fax:843-432-6740
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-22
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA336887363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty