Provider Demographics
NPI:1063561645
Name:FELDER, DIANE JOHNSON (MD)
Entity type:Individual
Prefix:DR
First Name:DIANE
Middle Name:JOHNSON
Last Name:FELDER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10215 OLIVIA VIEW LN
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-4797
Mailing Address - Country:US
Mailing Address - Phone:281-451-4327
Mailing Address - Fax:
Practice Address - Street 1:2520 NORTHWINDS PKWY
Practice Address - Street 2:SUITE 300
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30009-2216
Practice Address - Country:US
Practice Address - Phone:678-319-3747
Practice Address - Fax:888-656-5712
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH51222084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1753408Medicaid
TX122226703Medicaid
TXH5122OtherTX STATE LICENSE