Provider Demographics
NPI:1326834219
Name:ENGRAM, DIAMONE
Entity type:Individual
Prefix:
First Name:DIAMONE
Middle Name:
Last Name:ENGRAM
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2121 VANDIVERE RD APT F4
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30904-5480
Mailing Address - Country:US
Mailing Address - Phone:803-849-9196
Mailing Address - Fax:
Practice Address - Street 1:7 MARION YOUNG CT
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29801-9534
Practice Address - Country:US
Practice Address - Phone:803-646-2735
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-16
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician