Provider Demographics
NPI:1528623535
Name:HERRERA, DIEGO FERNANDO (DO)
Entity type:Individual
Prefix:
First Name:DIEGO
Middle Name:FERNANDO
Last Name:HERRERA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 NORTHSIDE DAWSON DR STE 100
Mailing Address - Street 2:
Mailing Address - City:DAWSONVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30534-7164
Mailing Address - Country:US
Mailing Address - Phone:404-847-4230
Mailing Address - Fax:404-847-4232
Practice Address - Street 1:81 NORTHSIDE DAWSON DR STE 100
Practice Address - Street 2:
Practice Address - City:DAWSONVILLE
Practice Address - State:GA
Practice Address - Zip Code:30534-7164
Practice Address - Country:US
Practice Address - Phone:855-647-7678
Practice Address - Fax:404-847-4232
Is Sole Proprietor?:No
Enumeration Date:2019-05-06
Last Update Date:2025-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA89688207QS0010X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine