1760243364 NPI number — DIANA TAWIAH ABABIO NP

Table of content: DIANA TAWIAH ABABIO NP (NPI 1760243364)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760243364 NPI number — DIANA TAWIAH ABABIO NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ABABIO
Provider First Name:
DIANA
Provider Middle Name:
TAWIAH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ABABIO
Provider Other First Name:
DIANA
Provider Other Middle Name:
TAWIAH
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
NP
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1760243364
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/19/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2701 N DECATUR RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DECATUR
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30033-5918
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-501-4200
Provider Business Mailing Address Fax Number:
404-501-4200

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2701 NORTH DECATUR ROAD 2701 NORTH DECATUR ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DECATUR
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30033
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-501-4200
Provider Business Practice Location Address Fax Number:
404-501-4200
Provider Enumeration Date:
01/19/2024

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: 363LF0000X , with the licence number:  NP186091 , 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)