Provider Demographics
NPI:1588441976
Name:POUNCIL, DIAMOND (NP)
Entity type:Individual
Prefix:
First Name:DIAMOND
Middle Name:
Last Name:POUNCIL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1425 GEORGIA AVE STE 201A
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-6546
Mailing Address - Country:US
Mailing Address - Phone:478-234-5767
Mailing Address - Fax:478-254-6860
Practice Address - Street 1:1425 GEORGIA AVE
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-6546
Practice Address - Country:US
Practice Address - Phone:478-250-1325
Practice Address - Fax:478-254-6860
Is Sole Proprietor?:No
Enumeration Date:2023-09-11
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GARN323478363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner