Provider Demographics
NPI:1992332092
Name:DIAMOND, DAVIS COPELAND (MD)
Entity type:Individual
Prefix:
First Name:DAVIS
Middle Name:COPELAND
Last Name:DIAMOND
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 1:1004 CHAFEE AVE
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30904-5810
Mailing Address - Country:US
Mailing Address - Phone:706-721-6231
Mailing Address - Fax:
Practice Address - Street 1:1004 CHAFEE AVE
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30904-5810
Practice Address - Country:US
Practice Address - Phone:706-721-6231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-26
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA11824207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology