Provider Demographics
NPI:1952432700
Name:DIABETES ASSOCIATION OF ATLANTA
Entity Type:Organization
Organization Name:DIABETES ASSOCIATION OF ATLANTA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:J
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-527-7150
Mailing Address - Street 1:100 EDGEWOOD AVE NE
Mailing Address - Street 2:SUITE 1004
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30303-3026
Mailing Address - Country:US
Mailing Address - Phone:404-572-7150
Mailing Address - Fax:404-527-7149
Practice Address - Street 1:100 EDGEWOOD AVE NE
Practice Address - Street 2:SUITE 1004
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30303-3026
Practice Address - Country:US
Practice Address - Phone:404-572-7150
Practice Address - Fax:404-527-7149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA71BBBRG133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty