Provider Demographics
NPI:1811187107
Name:DERRY, DIANA (BA)
Entity type:Individual
Prefix:MISS
First Name:DIANA
Middle Name:
Last Name:DERRY
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5670 PEACHTREE DUNWOODY RD NE
Mailing Address - Street 2:SUITE 1280
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1699
Mailing Address - Country:US
Mailing Address - Phone:404-257-1589
Mailing Address - Fax:404-303-1950
Practice Address - Street 1:5670 PEACHTREE DUNWOODY RD NE
Practice Address - Street 2:SUITE 1280
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1699
Practice Address - Country:US
Practice Address - Phone:404-257-1589
Practice Address - Fax:404-303-1950
Is Sole Proprietor?:No
Enumeration Date:2007-08-01
Last Update Date:2008-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAZ540231H00000X
GAAUD003803231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist