NPI 1700965159 · live from the CMS NPI Registry
Diana Spock Adebulehin, P.A.-C.
Physician Assistant, Surgical in Decatur, GA. National Provider Identifier 1700965159, active.
NPI record
| NPI | 1700965159 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Physician Assistant, Surgical 363AS0400X |
| Practice location | 1014 Sycamore Dr, Ste. B, Decatur, GA 30030 |
| Practice phone | 404-299-1700 |
| Mailing address | 200 Ivy Glen Cir, Avondale Estates, GA 30002 |
| Enumerated | November 6, 2006 |
| Last updated | July 9, 2007 |
| Sole proprietor | No |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Physician Assistant, Surgical primary | 363AS0400X | 004458 (GA) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.