Provider Demographics
NPI:1932769312
Name:DIAMOND, BENNIE GLORIA (MD)
Entity type:Individual
Prefix:DR
First Name:BENNIE
Middle Name:GLORIA
Last Name:DIAMOND
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:515 RIVER CROSSING DR STE 180
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29715-7901
Mailing Address - Country:US
Mailing Address - Phone:803-547-7541
Mailing Address - Fax:
Practice Address - Street 1:515 RIVER CROSSING DR STE 180
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29715-7901
Practice Address - Country:US
Practice Address - Phone:803-547-7541
Practice Address - Fax:803-548-0122
Is Sole Proprietor?:No
Enumeration Date:2019-06-18
Last Update Date:2023-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
SC888048207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine