Provider Demographics
NPI:1720165947
Name:DIAMOND, STEVEN CHARLES (MD)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:CHARLES
Last Name:DIAMOND
Suffix:
Gender:M
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:PO BOX 1377
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:GA
Mailing Address - Zip Code:31534-1377
Mailing Address - Country:US
Mailing Address - Phone:912-384-1477
Mailing Address - Fax:912-384-1470
Practice Address - Street 1:2010 OCILLA RD
Practice Address - Street 2:
Practice Address - City:DOUGLAS
Practice Address - State:GA
Practice Address - Zip Code:31533-2230
Practice Address - Country:US
Practice Address - Phone:912-384-1477
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA036135207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA937878OtherBC/BS
GA11D0909097OtherCLIA ID
GA341177OtherWELLCARE
GA036135OtherPHYSICIAN LICENSE
GA000669347CMedicaid
GADH1281OtherRAILROAD MEDICARE - GROUP #
GAP00473719OtherRAILROAD MEDICARE - PTAN
GAP00473719OtherRAILROAD MEDICARE - PTAN
GADH1281OtherRAILROAD MEDICARE - GROUP #
GABD3437212OtherDEA
GAG11648Medicare UPIN