Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | RN112295 | GA |
N | 363LP0200X | Nurse Practitioner - Pediatrics | RN112295 | GA |
NPI | 1073730032 |
---|---|
Provider Name | Mrs. Diane Arlene Doherty-Chandler |
First Address | Madison, GA 30650-3791 |
Second Address | Madison, GA 30650-3791 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2007 |
Last Update Date | 15/06/2016 |