Provider Demographics
NPI:1740896059
Name:DIMOND, CHARLENE RH (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:CHARLENE
Middle Name:RH
Last Name:DIMOND
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 NOBLE GLEN DR
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-7544
Mailing Address - Country:US
Mailing Address - Phone:912-656-1806
Mailing Address - Fax:
Practice Address - Street 1:89 INTERCHANGE DR
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:GA
Practice Address - Zip Code:31324-7664
Practice Address - Country:US
Practice Address - Phone:912-527-5253
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-22
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA156866363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty