1235147356 NPI number — MS. DIANE MARY HOOD RD,CDE, ACSM CES

Table of content: MS. DIANE MARY HOOD RD,CDE, ACSM CES (NPI 1235147356)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235147356 NPI number — MS. DIANE MARY HOOD RD,CDE, ACSM CES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOOD
Provider First Name:
DIANE
Provider Middle Name:
MARY
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
RD,CDE, ACSM CES
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DEPEW
Provider Other First Name:
DIANE
Provider Other Middle Name:
MARY
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
RD, ACSM EX. SPEC.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1235147356
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/29/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
855 DOCKBRIDGE WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALPHARETTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30004-3785
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-619-0042
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
855 DOCKBRIDGE WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALPHARETTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30004-3785
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-619-0042
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 133VN1006X , with the licence number:  LD002104 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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