Provider Demographics
NPI:1407999246
Name:DIAZ, FRANKLIN DANIEL (MD)
Entity type:Individual
Prefix:DR
First Name:FRANKLIN
Middle Name:DANIEL
Last Name:DIAZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:601 PROFESSIONAL DR STE 225A
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-7698
Mailing Address - Country:US
Mailing Address - Phone:770-513-8028
Mailing Address - Fax:770-513-8653
Practice Address - Street 1:601A PROFESSIONAL DRIVE STE 225
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-3325
Practice Address - Country:US
Practice Address - Phone:770-513-8028
Practice Address - Fax:770-513-8653
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA032374207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000473558CMedicaid
GA000473558BMedicaid
GA39BDBPSMedicare ID - Type UnspecifiedGROUP#GRP4429
GA000473558CMedicaid