Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 079097 | GA |
Y | 2081S0010X | Sports Medicine | 079097 | GA |
Y | 213ES0000X | Sports Medicine | 079097 | GA |
N | 2081S0010X | Sports Medicine | 79097 | GA |
N | 213ES0000X | Sports Medicine | 79097 | GA |
NPI | 1366750168 |
---|---|
Provider Name | Diara Satima Gross |
First Address | Atlanta, GA 30324-3086 |
Second Address | Atlanta, GA 30324-3086 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2010 |
Last Update Date | 30/04/2021 |