Provider Demographics
NPI:1962230466
Name:DARIAH, GERALD ETIEMOWEI (MD)
Entity type:Individual
Prefix:
First Name:GERALD
Middle Name:ETIEMOWEI
Last Name:DARIAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4028 PANOLA RD
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30038-3827
Mailing Address - Country:US
Mailing Address - Phone:404-579-1823
Mailing Address - Fax:
Practice Address - Street 1:1810 MOSERI RD
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30032-5116
Practice Address - Country:US
Practice Address - Phone:404-579-1823
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-25
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA400392084P0015X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0015XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychosomatic Medicine