Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 053005 | GA |
N | 2081P2900X | Pain Medicine | 053005 | GA |
NPI | 1093810798 |
---|---|
Provider Name | Dr. Diwakar Nagula |
First Address | Kingsland, GA 31548-0758 |
Second Address | Kingsland, GA 31548-6856 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/09/2006 |
Last Update Date | 08/07/2007 |